Broadway Ventures
Broadway Ventures is a multidisciplinary Enterprise IT, Artificial Intelligence, and cybersecurity professional services contractor and consultancy. We have offices in Vicksburg, Mississippi, and Amite, Louisiana and employees located across the United States. We have performed contracts throughout the U.S. and around the world. Broadway is an 8a Disadvantaged, Disabled Veteran, and HUBZone SBA certified small business. We are also a BDISBO certified Pennsylvania SBD and VBE.
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Registered Nurse – Training and Quality Control Coordinator
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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.
Job Description: Registered Nurse – Training and Quality Control Coordinator
Position Title: Registered Nurse – Training and Quality Control Coordinator
Company: Broadway Ventures, LLC
Location: Columbia, SC / Remote or Hybrid as assigned
Position Summary
Broadway Ventures is seeking a qualified Registered Nurse – Training and Quality Control Coordinator to support medical review operations for Palmetto GBA. This role is responsible for reviewing medical review decisions for accuracy, ensuring proper application of CMS guidelines, supporting quality control initiatives, training clinical staff, and assisting with provider inquiries and appeals-related medical coverage issues.
The ideal candidate will have strong clinical judgment, experience applying CMS instructions and medical review procedures, and the ability to provide education, feedback, and quality assurance support to medical review teams.
Key Responsibilities
The Registered Nurse – Training and Quality Control Coordinator will be responsible for the following:
- Review medical review decisions for accuracy and ensure CMS instructions and guidelines are applied correctly.
- Develop, implement, and support a quality control program designed to evaluate clinical staff’s technical knowledge and medical judgment.
- Provide feedback to management and staff regarding quality review findings.
- Deliver remedial training when necessary to address identified performance or knowledge gaps.
- Assist provider service departments with medical coverage issues to ensure consistent application of CMS guidelines.
- Respond to specific provider inquiries and appeals requests related to medical coverage and review decisions.
- Develop and maintain departmental reference manuals used to support proper application of CMS instructions.
- Provide continuing education workshops for medical reviewers on coverage issues, CMS updates, and medical advances.
- Train new staff on CMS guidelines, medical review procedures, and internal review processes.
- Prepare monthly reports for management outlining quality control results, adjustment data, and reopening results summaries.
- Provide input to the medical review audit department regarding actions taken in response to provider billing practices to help identify and target potential program abuse.
Required Qualifications
- Active and unrestricted Registered Nurse license.
- Strong knowledge of CMS guidelines, medical review procedures, and healthcare coverage requirements.
- Experience reviewing medical documentation and applying clinical judgment to coverage or medical necessity decisions.
- Ability to evaluate clinical staff performance and provide constructive feedback.
- Experience developing or supporting quality control, quality assurance, or audit programs.
- Strong written and verbal communication skills.
- Ability to create reports, reference materials, training guides, and educational content.
- Strong organizational skills and attention to detail.
- Ability to work independently and collaborate with management, clinical staff, provider service teams, and audit departments.
Preferred Qualifications
- Prior experience with Medicare, Medicaid, CMS contractors, or healthcare claims review.
- Experience responding to provider inquiries, appeals, or coverage-related requests.
- Background in medical review, utilization review, quality assurance, auditing, or clinical education.
- Experience training clinical staff or developing continuing education workshops.
- Familiarity with provider billing practices and program integrity concepts.
Knowledge, Skills, and Abilities
- Advanced clinical assessment and medical judgment skills.
- Understanding of CMS instructions and their application to medical review decisions.
- Ability to identify trends, errors, and training needs through quality control reviews.
- Strong analytical skills for preparing monthly management reports.
- Ability to communicate complex medical coverage issues clearly and professionally.
- Commitment to accuracy, compliance, consistency, and continuous improvement.
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).
Ready to apply?
Apply to Broadway Ventures
Remote Medical Claims Reviewer (Home Health)
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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 has an opening for a Medical Claims Reviewer. This team handles a variety of claim types including Radiology, Ambulance, Physical Therapy and Surgical. Performs medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or clinical guidelines. Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices.
Max Salary: W-2 ($65,000/$31.25)
Worksite:
This is a Work-from-home position
Job Responsibilities
- Performs medical claim reviews for one or more of the following: claims for medically complex services, services that require preauthorization/predetermination, requests for appeal or reconsideration, referrals for potential fraud and/or abuse, and correct coding for claims/operations.
- Makes reasonable charge payment determinations based on clinical/medical information and established criteria/protocol sets or clinical guidelines.
- Determines medical necessity and appropriateness and/or reasonableness and necessity for coverage and reimbursement.
- Documents medical rationale to justify payment or denial of services and/or supplies.
- Educates internal/external staff regarding medical reviews, medical terminology, coverage determinations, coding procedures, etc. in accordance with contractor guidelines.
- Participates in quality control activities in support of the corporate and team-based objectives.
- Provides guidance, direction, and input as needed to LPN team members.
- Provides education to non-medical staff through discussions, team meetings, classroom participation and feedback.
- Assists with special projects and specialty duties/responsibilities as assigned by Management.
Required Education: Associate's in a job related field
Degree Equivalency: Graduate of Accredited School of Nursing
Required Experience: 2 years clinical experience plus 2 years utilization/medical review, quality assurance, or home health experience.
Required Skills and Abilities:
- Working knowledge of managed care and various forms of health care delivery systems; strong clinical experience to include home health, rehabilitation, and/or broad medical surgical experience.
- Knowledge of specific criteria/protocol sets and the use of the same.
- 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.
- Ability to persuade, negotiate, or influence others.
- Analytical or critical thinking skills .
- Ability to handle confidential or sensitive information with discretion.
Required Software and Tools:
- Microsoft Office.
Required Licenses and Certificates:
- Active, unrestricted RN licensure from the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC), OR, current active, unrestricted licensure/certification from the United States and in the state of hire in specialty area as required by hiring division/area.
Preferred Education:
- Bachelor's degree-Nursing or Graduate of accredited School of Nursing.
Preferred Work Experience:
- 3 years-utilization/medical review, quality assurance, or home health, plus 5 years clinical experience.
Preferred Skills and Abilities:
- Knowledge of spreadsheet and database software.
- Knowledge of Medicare and/or regulations/policies/instructions/provisions, home health, and/or system/processing procedures for medical review.
Preferred Software and Other Tools:
- Working knowledge of Microsoft Excel, Access, or other spreadsheet database software.
Broadway Ventures is an equal opportunity employer and VEVRAA Federal Contractor. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Disability insurance
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
- Work from home
Schedule:
- 8 hour shift
- Monday to Friday
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).
Ready to apply?
Apply to Broadway Ventures
Remote RN – Medical Claims Reviewer
Share this job
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.
Job Type: Full-time (40 hours/week)
Schedule: Monday–Friday, 8:00 AM – 5:00 PM
Max Salary: W-2 ($65,000/$31.25)
Location: Remote (U.S. – Work from home)
Remote Work Requirements: High-speed internet (non-satellite) and a private, lockable home office
Equipment: You will be provided with all necessary equipment to perform your job effectively, including but not limited to a desktop computer, dual monitors, a headset, an ethernet cable, and additional accessories as needed.
About the Role
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.
Key Responsibilities
- Review medically complex claims, pre-authorization requests, appeals, and fraud/abuse referrals.
- Assess payment determinations using clinical information and established guidelines.
- Evaluate medical necessity, appropriateness, and reasonableness for coverage and reimbursement.
- Provide clear, well-documented rationales for service approvals or denials.
- Educate internal and external teams on medical review processes, coverage determinations, and coding requirements.
- Support quality control activities to meet corporate and team objectives.
- Provide guidance to LPN team members and support non-clinical staff through training and discussions.
- Assist with special projects and additional responsibilities as assigned.
Minimum Qualifications
Licensure:
- Active, unrestricted RN license in the U.S. and in the state of hire
OR - Active compact multistate RN license (as defined by the Nurse Licensure Compact).
Education:
- Associate Degree in Nursing
OR - Graduate of an accredited School of Nursing.
Experience:
- Two years of clinical experience plus at least two years in one of the following:
- Home Health
- Utilization/Medical Review
- Quality Assurance
Skills & Competencies:
- Strong clinical background in managed care, home health, rehabilitation, and/or medical-surgical settings.
- Ability to interpret and apply medical review criteria and clinical guidelines.
- Proficiency in Microsoft Office and word processing software.
- Strong analytical, organizational, and decision-making skills.
- Ability to work independently while managing priorities effectively.
- Excellent customer service, communication, and critical thinking skills.
- Ability to handle confidential information with discretion.
Preferred Qualifications
- Three years of clinical nursing experience in Home Health, Utilization Review, Medical Review, or Quality Assurance (strongly preferred).
- Proficiency in using multiple screens and software programs simultaneously.
If you are a detail-oriented RN with a passion for medical review, we encourage you to apply!
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).
Ready to apply?
Apply to Broadway Ventures
Remote RN – Medical Claims Reviewer
Share this job
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.
Max Salary: W-2 ($65,000/$31.25)
Job Type: Full-time (40 hours/week)
Schedule: Monday–Friday, 8:00 AM – 5:00 PM EST (core hours)
Location: Remote (U.S. – Work from home)
Remote Work Requirements: High-speed internet (non-satellite) and a private, lockable home office
Equipment: You will be provided with all necessary equipment to perform your job effectively, including but not limited to a desktop computer, dual monitors, a headset, an ethernet cable, and additional accessories as needed.
About the Role:
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.
Key Responsibilities:
- Review medically complex claims, pre-authorization requests, appeals, and fraud/abuse referrals.
- Assess payment determinations using clinical information and established guidelines.
- Evaluate medical necessity, appropriateness, and reasonableness for coverage and reimbursement.
- Provide clear, well-documented rationales for service approvals or denials.
- Educate internal and external teams on medical review processes, coverage determinations, and coding requirements.
- Support quality control activities to meet corporate and team objectives.
- Assist with special projects and additional responsibilities as assigned.
Minimum Qualifications:
Licensure:
- Active, unrestricted RN license in the U.S. and in the state of hire
OR - Active compact multistate RN license (as defined by the Nurse Licensure Compact).
Education:
- Associate Degree in Nursing
OR - Graduate of an accredited School of Nursing.
Experience:
- Two years of clinical experience plus at least two years in one of the following:
- Inpatient/Outpatient settings (i.e. medical-surgical, rehabilitation, SNF, etc..)
- Utilization/Medical Review
- Quality Assurance
Skills & Competencies:
- Strong clinical background in managed care and/or inpatient/outpatient
settings.
- Ability to interpret and apply medical review criteria and clinical guidelines.
- Proficiency in Microsoft Office and word processing software.
- Strong analytical, organizational, and decision-making skills.
- Ability to work independently while managing priorities effectively.
- Excellent customer service, communication, and critical thinking skills.
- Ability to handle confidential information with discretion.
Preferred Qualifications:
- Three years of clinical nursing experience in Inpatient/Outpatient settings, Utilization Review, Medical Review, or Quality Assurance (strongly preferred).
- 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.
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).
Ready to apply?
Apply to Broadway Ventures