Senior Medical Reviewer

Job description

At **Broadway Ventures**, we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), we empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth. Built on integrity, collaboration, and excellence, we’re more than a service provider—we’re your trusted partner in innovation. **Compensation Range: $68,000 – 70,000 per annum** **Start Date: November 2026** ### About Broadway Ventures Broadway Ventures, LLC is a certified small business government contractor providing healthcare administration and IT services to federal agencies, including CMS, the VA, and DoD. ### Position Summary We are seeking an experienced Registered Nurse to directly supervise a team of RN Medical Reviewers supporting Medicare medical review operations. This role owns daily workload distribution and turnaround performance, ensures compliance with CMS and client security requirements, and serves as the first line of escalation for case risk, provider concerns, and integrity matters. ### Key Responsibilities - Directly supervise a team of approximately 20 RN Medical Reviewers, managing day-to-day case assignment and workload distribution - Monitor case turnaround daily against the 7-business-day requirement, reviewing the case management system to identify cases approaching their due date and rebalancing workload to prevent bottlenecks - Flag any case at risk of missing turnaround by day 5 of the 7-business-day window, reassigning to a reviewer with capacity or escalating to expedite completion - Confirm and escalate provider concerns and complaints, suspected fraud, aberrant billing behavior, and data or privacy incidents to the client within required timeframes — one business day, or immediately for fraud and security matters - Conduct periodic virtual desk audits of assigned RN Medical Reviewers' remote work environments to confirm compliance with CMS and client security and location requirements - Mentor newly onboarded RN Medical Reviewers on client-furnished systems and procedures once approved for independent production - Report turnaround performance and workload/staffing risk to the Project Manager daily ### Minimum Qualifications - Active, unrestricted, and unencumbered RN license (single-state or compact multistate) - ADN or accredited nursing degree (BSN preferred) - 5+ years of nursing experience, including 2+ years in Medicare medical review or utilization review (UR). Equivalent combinations of clinical and Medicare review experience will be considered. - Strong documentation and independent decision-making skills, with the ability to oversee a reviewer caseload and workload distribution under strict deadlines - Must reside and work from within the U.S., D.C., or a U.S. territory - Private, secure home workspace meeting CMS security requirements ### Preferred Qualifications - Direct home health RCD or comparable MAC medical review experience - Existing familiarity with home health pre-claim review documentation, including face-to-face encounter notes, comprehensive assessments, plans of care, certifications and recertifications, and homebound/medical necessity documentation - Prior MAC, RCD, or CMS program integrity experience across multiple jurisdictions (e.g., Jurisdiction J/M) ### Conditions of Employment - RN license will be verified prior to assignment and monthly thereafter - Must maintain a private, secure remote work environment meeting CMS security requirements, subject to periodic virtual desk audits **What to Expect Next:** After submitting your application, our recruiting team will review your qualifications. This may include a brief telephone interview or email communication to verify resume details and discuss compensation expectations. Interviews will be conducted with the most qualified candidates. Broadway Ventures conducts background checks and drug testing prior to the start of employment. Some positions may also require fingerprinting. Broadway Ventures is an equal opportunity employer and a VEVRAA federal contractor. We do not discriminate against applicants or employees on the basis of race, color, religion, sex, national origin, age, disability, protected veteran status, or any other status protected by applicable law. Reasonable accommodations are available for applicants with disabilities. Broadway Ventures utilizes the OFCCP-approved Voluntary Self-Identification of Disability Form (CC-305). *The pay range shown is a good-faith estimate of the compensation Broadway Ventures reasonably expects to pay for this position at the time of posting. It is not a guarantee of any particular wage, salary, or total compensation. Actual pay offered depends on job-related factors, which may include skills, experience, education, certifications and licensure, geographic work location, contract funding and budget. For positions covered by the Service Contract Act, pay is also governed by the applicable Department of Labor wage determination, which the government may revise.* *Some positions are posted in support of a contract proposal that has not yet been awarded. Where that is the case, the position and its final compensation are contingent upon award of the contract to Broadway Ventures and on the terms of the awarded contract, including any government-approved labor rates and the applicable wage determination.* *Broadway Ventures offers a comprehensive benefits package. A general description of benefits is below.* - *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*