<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"> 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. </div> </div></div>Pay Rate: $62,000-$65,000 Location: Remote About Broadway Ventures 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. Position Summary 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. Essential Duties and Responsibilities <ul> <li>Review all claims subject to medical review in accordance with applicable statute, regulation, CMS guidelines, and coverage requirements</li> <li>Conduct pre-claim review (PCR) for IRF services within designated review areas</li> <li>Complete complex medical reviews of PCR requests within 2 business days of receipt, including resubmissions</li> <li>Complete pre-payment complex medical reviews of ADR responses within 30 calendar days of receipt</li> <li>Complete post-payment complex medical reviews of ADR responses within 60 calendar days of receipt</li> <li>Complete complex medical reviews of reopened ADR responses within 60 calendar days of receipt</li> <li>Render affirmative or non-affirmative determinations on each PCR request, assigning a Unique Tracking Number (UTN) per billing period; treat incomplete documentation packages as non-affirmed</li> <li>Conduct provider phone calls to communicate review determinations and provide education on non-affirmed decisions</li> <li>Maintain accurate, timely documentation of all review activity in accordance with contract and CMS requirements</li> </ul> Minimum Qualifications <ul> <li>Active, unrestricted Registered Nurse (RN) license; compact license preferred</li> <li>Minimum of 2–3 years of clinical nursing experience; rehabilitation, acute care, or case management background preferred</li> <li>Prior experience in Medicare medical review, utilization review, or claims review strongly preferred</li> <li>Working knowledge of CMS coverage guidelines, IRF medical necessity criteria, and Medicare Administrative Contractor (MAC) review processes</li> <li>Strong analytical and clinical decision-making skills, with the ability to interpret m

Medical Review II (Medicare)

Job Description