Medical Reviewer (1099 Contract) (Remote)

Broadway Ventures LLC; United States; Remote; USD 39,000 - 43,000; Full time

Job summary

Broadway Ventures is seeking a Medical Reviewer (1099 contract) on a remote basis for the United States. The role involves reviewing PCR packages for Medicare coverage and coding, documenting outcomes with clinical rationale, and engaging with providers as needed. Start date December 2026. A strong focus on accuracy and QA is required.

Minimum RN licensure and 2+ years in clinical work, including home health or utilization review, are essential; ICD coding proficiency is a plus.

Qualifications

• Active, unrestricted RN license in their state of residence.
• Minimum 2 years of clinical experience plus at least 2 years in home health, QA, or utilization review.
• Preferred: home health experience (OASIS, MAC/RCD/CMS program integrity) or prior involvement with program integrity.

Responsibilities

• Review home health pre-claim review (PCR) packages for Medicare coverage, coding, and payment criteria.
• Document review outcomes with clinical rationale in the designated system, with 7 business days turnaround.

Skills

RN Medical Reviewer

Clinical experience

Home health

ICD coding

Job description

Medical Reviewer (1099 Contract) (Remote)

United States

AtBroadway 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.

Compensation rate: $28.85 - $31.25/hr. on a 1099 basis

Start Date: December 2026

Key Responsibilities:

Conduct comprehensive reviews of home health pre-claim review (PCR) packages to determine compliance with Medicare coverage, coding, and payment criteria.

Document review outcomes (affirmation/non-affirmation) with well-defined clinical rationale in the designated case management system, ensuring a turnaround time of within 7 business days.

Engage with providers, as authorized, to request or clarify documentation, and elevate any provider concerns or suspected fraud in accordance with established program procedures.

• Maintain a standard of 98% accuracy and fulfill all required training, quality assurance reviews, and inter-rater reliability sessions.

Minimum Qualifications:

• All RN Medical Reviewers must possess the following minimum qualifications: an active, unrestricted RN license in their state of residence.
• A minimum of 2 years of clinical experience, along with at least 2 years of experience in home health, quality assurance, or utilization review.

Preferred Qualifications:

• Experience in home health (OASIS, Medicare Conditions of Participation) or prior involvement with MAC/RCD/CMS program integrity.
• Proficiency in ICD coding.

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
• Company provided Life Insurance and Voluntary Life Insurance
• Short Term Disability and Long Term Disability

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 hiringprocess 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.

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 measurethe 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.