Medical Review II (Medicare)

The role

A licensed Registered Nurse will perform complex medical review of Medicare claims for Inpatient Rehabilitation Facility services. This role involves conducting pre-claim review determinations, evaluating documentation responses, and communicating with providers.

What you will do

• Perform complex medical review of Medicare claims for Inpatient Rehabilitation Facility services
• Conduct pre-claim review (PCR) determinations
• Evaluate Additional Documentation Request (ADR) responses
• Communicate determinations directly to providers

Required qualifications

• Associate Degree – Nursing, or Graduate of an accredited School of Nursing
• 2 years clinical experience
• 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
• Analytical or critical thinking skills
• Ability to handle confidential or sensitive information with discretion
• Microsoft Office
• Active RN licensure in state hired, OR active compact multistate RN license as defined by the Nurse Licensure Compact (NLC)

Nice to have

• Bachelor's degree – Nursing, OR Graduate of an Accredited School of Nursing
• Preferred experience minimum 3 years RN clinical experience
• Critical care/ICU/ER experience
• Knowledge of spreadsheet and database software
• Ability to persuade, negotiate, or influence others
• Working knowledge of managed care and various current forms of health care delivery systems; strong clinical experience — home health, rehabilitation, and/or broad medical surgical experience
• Knowledge of Medicare and/or regulations/policies/instructions/provisions, home health, system/processing procedures for medical review
• Knowledge of or ability to learn specific criteria/protocol sets and the use of the same
• Working knowledge of Microsoft Excel, Access, or other spreadsheet/database software

Benefits

• 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

Before you apply

• Broadway Ventures conducts background checks and drug testing prior to the start of employment
• Some positions may also require fingerprinting
• Candidates must live in and work from an eligible U.S. state
• An artificial intelligence tool is used to review applications by comparing resumes to requirements

About the company

Broadway Ventures is a Service-Disabled Veteran-Owned Small Business (SDVOSB) and HUBZone-certified firm headquartered in Vicksburg, Mississippi. They support federal clients across the Centers for Medicare & Medicaid Services (CMS) and the Department of Defense.