Remote RN Medical Review Manager — Medicare

Broadway Ventures LLC; Northern (KY); Hybrid; USD 68,000 - 70,000; Full time

Benefits offered by this job

401(k) and company match

PTO that grows with tenure

Life Insurance

Disability Insurance

Job summary

Broadway Ventures seeks an experienced Registered Nurse to supervise a team of RN Medical Reviewers supporting Medicare medical review operations. You will own workload distribution, ensure CMS security compliance, and serve as the first line of escalation for case risk and integrity matters.

Direct leadership of approximately 20 reviewers, with accountability for turnaround performance and adherence to CMS guidelines, is expected. Private home workspace and U.S. residency are required.

Qualifications

• Active, unrestricted RN license.
• 5+ years nursing experience, including 2+ years in Medicare medical review or UR.
• Strong documentation and independent decision-making skills.
• Must reside and work from within the U.S., D.C., or a U.S. territory.
• Private, secure home workspace meeting CMS security requirements.

Responsibilities

• Directly supervise a team of RN Medical Reviewers, managing day-to-day case assignment and workload distribution.
• Monitor case turnaround to ensure adherence to the 7-business-day requirement.
• Flag risks and reassign or escalate to expedite completion.
• Report provider concerns, fraud, and security incidents within required timeframes.
• Mentor new RN Medical Reviewers on client systems and procedures.

Skills

RN license

Medicare review

Team supervision

CMS security

Remote work

Job description

Broadway Ventures seeks an experienced Registered Nurse to supervise a team of RN Medical Reviewers supporting Medicare medical review operations. You will own workload distribution, ensure CMS security compliance, and serve as the first line of escalation for case risk and integrity matters.

Direct leadership of approximately 20 reviewers, with accountability for turnaround performance and adherence to CMS guidelines, is expected. Private home workspace and U.S. residency are required.