Broadway Ventures - Remote RN – Medical Claims Reviewer

• Equipment • We are seeking a dedicated Registered Nurse (RN) to join our Medical Review team. This role involves conducting pre- and post-payment medical reviews to ensure compliance with established clinical criteria and guidelines. The ideal candidate will use their clinical expertise to assess medical necessity, appropriateness, and reimbursement eligibility while documenting decisions in accordance with regulatory and organizational requirements. • Registered Nurse (RN) • Medical Review team • pre- and post-payment medical reviews • Licensure: • Active, unrestricted RN license in the U.S. and in the state of hireOR • Active compact multistate RN license (as defined by the Nurse Licensure Compact). • compact multistate RN license • Education: • Associate Degree in NursingOR • Graduate of an accredited School of Nursing. • Two years of clinical experience plus at least two years in one of the following: • Two years • two years • Inpatient/Outpatient settings (i.e. medical-surgical, rehabilitation, SNF,  etc..) • Utilization/Medical Review • Quality Assurance • Quality Assurance • Strong clinical background in managed care and/or inpatient/outpatient • managed care and/or inpatient/outpatient • settings • Ability to interpret and apply medical review criteria and clinical guidelines. • medical review criteria and clinical guidelines • Proficiency in Microsoft Office and word processing software. • Microsoft Office • Strong analytical, organizational, and decision-making skills. • analytical, organizational, and decision-making skills • Ability to work independently while managing priorities effectively. • Excellent customer service, communication, and critical thinking skills. • customer service, communication, and critical thinking skills • Ability to handle confidential information with discretion. • Three years of clinical nursing experience in Inpatient/Outpatient settings, Utilization Review, Medical Review, or Quality Assurance (strongly preferred). • Three years • Inpatient/Outpatient settings, Utilization Review, Medical Review, or Quality Assurance • Proficiency in using multiple screens and software programs simultaneously. • Training and experience in ICD coding. • 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.