Medical Reviewer (1099 Contract) (Remote)

<div class="content-intro"><div class="et_pb_module et_pb_text et_pb_text_0 et_pb_text_align_left et_pb_bg_layout_light"> <div class="et_pb_text_inner"> <p style="text-align: justify;">At <strong>Broadway Ventures</strong>, 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.</p> </div> </div></div><h2>Compensation rate: $28.85 - $31.25/hr. on a 1099 basis</h2> <h2>Start Date: December 2026</h2> <h2>Key Responsibilities:</h2> <ul> <li> <p>Conduct comprehensive reviews of home health pre-claim review (PCR) packages to determine compliance with Medicare coverage, coding, and payment criteria.</p> </li> <li> <p>Document review outcomes (affirmation/non-affirmation) with well-defined clinical rationale in the designated case management system, ensuring a turnaround time of within 7 business days.</p> </li> <li> <p>Engage with providers, as authorized, to request or clarify documentation, and escalate any provider concerns or suspected fraud in accordance with established program procedures.</p> </li> <li>Maintain a standard of 98% accuracy and fulfill all required training, quality assurance reviews, and inter-rater reliability sessions.</li> </ul> <h2>Minimum Qualifications:</h2> <ul> <li><span data-teams="true">All RN Medical Reviewers must possess the following minimum qualifications: an active, unrestricted RN license in their state of residence.</span></li> <li><span data-teams="true">A minimum of 2 years of clinical experience, along with at least 2 years of experience in home health, quality assurance, or utilization review. </span></li> </ul> <h2>Preferred Qualifications:</h2> <ul> <li>Experience in home health (OASIS, Medicare Conditions of Participation) or prior involvement with MAC/RCD/CMS program integrity.</li> <li>Proficiency in ICD coding.</li> </ul> <p> </p><div class="content-conclusion"><p> </p> <p data-start="1731" data-end="1755"><strong data-start="1731" data-end="1755">What to Expect Next:</strong></p> <p data-start="1757" data-end="2185">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.</p> <p data-start="2187" data-end="2478">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.</p> <p data-start="2480" data-end="2658">Reasonable accommodations are available for applicants with disabilities. Broadway Ventures utilizes the OFCCP-approved Voluntary Self-Identification of Disability Form (CC-305).</p> <p><em>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 post