Job Application for Medical Review II (Medicare) at Broadway Ventures

New

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.

Essential Duties and Responsibilities:

Reviews all claims subject to medical review in accordance with applicable statutes, regulations, CMS guidelines, and coverage requirements.
Conducts pre-claim review (PCR) for Inpatient Rehabilitation Facility (IRF) services within designated review areas.
Completes complex medical reviews of PCR requests within 2 business days of receipt, including resubmissions.
Completes pre-payment complex medical reviews of Additional Documentation Request (ADR) responses within 30 calendar days of receipt.
Completes post-payment complex medical reviews of ADR responses within 60 calendar days of receipt.
Completes complex medical reviews of reopened ADR responses within 60 calendar days of receipt.
Renders affirmative or non-affirmative determinations on each PCR request, assigning a Unique Tracking Number (UTN) per billing period, and treats incomplete documentation packages as non-affirmed.
Conducts provider phone calls to communicate review determinations and provide education on non-affirmed decisions.
Maintains accurate and timely documentation of all review activity in accordance with contract and CMS requirements.

Minimum Qualifications:

Active, unrestricted Registered Nurse (RN) license (compact license preferred).
Minimum of 2–3 years of clinical nursing experience, with a background in rehabilitation, acute care, or case management preferred.
Working knowledge of CMS coverage guidelines, IRF medical necessity criteria, and Medicare Administrative Contractor (MAC) review processes.
Strong analytical and clinical decision-making skills, with the ability to interpret medical records against regulatory criteria.
Excellent written and verbal communication skills, including experience conveying review determinations directly to providers.
Proficiency with Microsoft Office and claims/medical review software systems.
Ability to consistently meet contractual review turnaround deadlines in a production-driven environment.

Preferred Qualifications:

Experience specifically with Inpatient Rehabilitation Facility (IRF) documentation and CMS Review Choice Demonstration (RCD) programs.
Certification in case management, utilization review, or a related specialty (e.g., CCM, ACM).
Minimum of 2–3 years of clinical nursing experience, with rehabilitation, acute care, or case management background preferred.

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

First Name

Last Name

Preferred First Name

Country

Phone

Location (City)

Resume/CV*

Accepted file types: pdf, doc, docx, txt, rtf

Cover Letter

Accepted file types: pdf, doc, docx, txt, rtf

School

Select...

Degree

Select...

Discipline

Select...

Start date year

End date year

What is your LinkedIn Profile address?

What is your Street Address?

What City/Town do you live in?

What State do you live in (Abbreviated)?

Select...

Please enter your zip code-

Are you a US Citizen?

Select...

What is the highest level of education you have completed?

Do you have a valid RN License?

Select...

Please list your full name as it appears on your RN License.

How many years of experience do you have working as a Registered Nurse in a clinical setting?

How many years of Utilization/Medical Review, Quality Assurance or Home Health experience do you have?

Do you have access to high-speed internet and are able to connect your computer through an ethernet cable?

Select...

What are your salary expectations for this position?

Is our Max Salary: W-2 ($65,000/$31.25) within your acceptable range?

Select...

How did you hear about this role? If you became aware of this role via internal referral, please list the Broadway Ventures employee who referred you.

I certify that the information I have provided in this application, my resume, and any accompanying materials is true, accurate, and complete to the best of my knowledge. I understand that any misrepresentation, falsification, or material omission - whether discovered before or after hire - may result in the rejection of my application or, if I am employed, disciplinary action up to and including termination of employment, regardless of when the misrepresentation is discovered. I authorize Broadway Ventures, LLC to verify any of the information provided, including by contacting former employers, educational institutions, and references, to the extent permitted by law.

Select...

Voluntary Self-Identification

For government reporting purposes, we ask candidates to respond to the below self-identification survey. Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiring process or thereafter. Any information that you do provide will be recorded and maintained in a confidential file.

As set forth in Broadway Ventures’s Equal Employment Opportunity policy, we do not discriminate on the basis of any protected group status under any applicable law.

Gender

Select...

Are you Hispanic/Latino?

Select...

Race & Ethnicity Definitions

If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection. As a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Classification of protected categories is as follows:

A "disabled veteran" is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability.

A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.

An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.

An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.

Veteran Status

Select...

Voluntary Self-Identification of Disability

Form CC-305

Page 1 of 1

OMB Control Number 1250-0005

Expires 07/31/2029

Why are you being asked to complete this form?

We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says we must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years.

Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you want to learn more about the law or this form, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

How do you know if you have a disability?

A disability is a condition that substantially limits one or more of your “major life activities.” If you have or have ever had such a condition, you are a person with a disability. Disabilities include, but are not limited to:

Alcohol or other substance use disorder (not currently using drugs illegally)
Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS
Blind or low vision
Cancer (past or present)
Cardiovascular or heart disease
Celiac disease
Cerebral palsy
Deaf or serious difficulty hearing
Diabetes
Disfigurement, for example, disfigurement caused by burns, wounds, accidents, or congenital disorders
Epilepsy or other seizure disorder
Gastrointestinal disorders, for example, Crohn's Disease, irritable bowel syndrome
Intellectual or developmental disability
Mental health conditions, for example, depression, bipolar disorder, anxiety disorder, schizophrenia, PTSD
Missing limbs or partially missing limbs
Mobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supports
Nervous system condition, for example, migraine headaches, Parkinson’s disease, multiple sclerosis (MS)
Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities
Partial or complete paralysis (any cause)
Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema
Short stature (dwarfism)
Traumatic brain injury

Disability Status

Select...

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.

Medical Review II (Medicare)

Essential Duties and Responsibilities:

Minimum Qualifications:

Preferred Qualifications:

Apply for this job

Voluntary Self-Identification

Voluntary Self-Identification of Disability