Medical Claim Reviewer (CGS, DMEC)

At Broadway Ventures, we are seeking a dedicated Registered Nurse (RN) to join our Medical Review team as a Medical Claim Reviewer. This role involves conducting pre- and post-payment medical reviews to ensure compliance with established clinical criteria and guidelines.

Requirements

• 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
• Skills: 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

Benefits

• Generous Paid Time Off
• 401k Matching
• Retirement Plan
• Visa Sponsorship