Medical Review II (Medicare)
Broadway Ventures
•$62,000 - $65,000•Remote
About The Position
Broadway Ventures is seeking a licensed Registered Nurse to perform complex medical review of Medicare claims for Inpatient Rehabilitation Facility (IRF) services. This role conducts pre-claim review (PCR) determinations, evaluates Additional Documentation Request (ADR) responses, and communicates determinations directly to providers. Work is production-driven and governed by strict contractual turnaround requirements.
Requirements
- Associate Degree – Nursing, or Graduate of an accredited School of Nursing
- 2 years clinical experience
- Working knowledge of word processing software
- Ability to work independently, prioritize effectively, and make sound decisions
- Good judgment skills
- Demonstrated customer service and organizational skills
- Demonstrated oral and written communication skills
- Analytical or critical thinking skills
- Ability to handle confidential or sensitive information with discretion
- Microsoft Office
- Active RN licensure in state hired, OR active compact multistate RN license as defined by the Nurse Licensure Compact (NLC)
Nice To Haves
- Bachelor's degree – Nursing, OR Graduate of an Accredited School of Nursing
- Preferred experience minimum 3 years RN clinical experience
- Knowledge of spreadsheet and database software
- Ability to persuade, negotiate, or influence others
- Working knowledge of managed care and various current forms of health care delivery systems; strong clinical experience — home health, rehabilitation, and/or broad medical surgical experience
- Knowledge of Medicare and/or regulations/policies/instructions/provisions, home health, system/processing procedures for medical review
- Knowledge of or ability to learn specific criteria/protocol sets and the use of the same
- Working knowledge of Microsoft Excel, Access, or other spreadsheet/database software
Responsibilities
- Conducts pre-claim review (PCR) determinations
- Evaluates Additional Documentation Request (ADR) responses
- Communicates determinations directly to providers
Benefits
- 401(k) and company match
- PTO that grows the longer you stay
- Health, Vision, Dental
- Company provided Life Insurance and Voluntary Life Insurance
- Short Term Disability and Long Term Disability
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
