Medical Review II (Medicare)

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Quick Summary

Requirements Summary

Associate Degree – Nursing, or Graduate of an accredited School of Nursing. Work Experience: 2 years clinical experience. Skills and Abilities: Working knowledge of word processing software.

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OtherHealthcarePhysicianNetwork

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.

Broadway Ventures is a Service-Disabled Veteran-Owned Small Business (SDVOSB) and HUBZone-certified firm headquartered in Vicksburg, Mississippi. We support federal clients across the Centers for Medicare & Medicaid Services (CMS) and the Department of Defense, with a workforce that is approximately 95% remote.

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

~4 min read

Education Level and Degree Type:

  • Associate Degree – Nursing, or Graduate of an accredited School of Nursing.

Work Experience:

  • 2 years clinical experience.

Skills and Abilities:

  • 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.

Software and Other Tools:

  • Microsoft Office.

Licenses and Certificates:

  • Active RN licensure in state hired, OR active compact multistate RN license as defined by the Nurse Licensure Compact (NLC).

Education Level and Degree Type:

  • Bachelor's degree – Nursing, OR Graduate of an Accredited School of Nursing.

Work Experience:

  • Preferred experience minimum 3 years RN clinical experience.
  • Critical care/ICU/ER experience

Skills and Abilities:

  • 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.

Software and Other Tools:

  • Working knowledge of Microsoft Excel, Access, or other spreadsheet/database software. 

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.

Location Eligibility: Broadway Ventures cannot consider applicants who live in, or would work from, any of the following locations: California, Colorado, Connecticut, the District of Columbia, Hawaii, Illinois, Maryland, Massachusetts, New Jersey, New York, North Dakota, Ohio, Oregon, Rhode Island, Washington State, and Wyoming. Candidates must live in and work from an eligible U.S. state when they are hired and for as long as they are employed. Applications from residents of the locations listed above will not be considered.

Notice: Use of Artificial Intelligence in Our Hiring Process

Broadway Ventures uses an artificial intelligence (AI) tool to help review applications for this position.

  • Who built it: Broadway Ventures developed the tool in-house.
  • What it does: It compares your resume to the requirements in this job posting and gives a score from 0 to 100 showing how closely your qualifications match.
  • What information it uses: The text of your resume, your name, your current or most recent job title, your location, and this job posting.
  • What it cannot see: Your answers to voluntary demographic or equal employment opportunity questions, interview feedback, or offer information.
  • How it is used: The score is one factor in our initial review of applications. The tool does not reject anyone. A member of our recruiting team reviews every application before any decision is made.
  • Your options: If you would like your application reviewed without the AI tool, or you need a reasonable accommodation at any point in the hiring process, contact us at recruiting@broadwayventures.net. Making a request will not affect whether you are considered for this position.

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

 

Location & Eligibility

Where is the job
United States
On-site within the country
Who can apply
US

Listing Details

Posted
August 26, 2026
First seen
August 26, 2026
Last seen
October 14, 2026

Posting Health

Days active
48
Repost count
0
Trust Level
22%
Scored at
October 14, 2026

Signal breakdown

freshnesssource trustcontent trustemployer trust
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Medical Review II (Medicare)