Remote RN Medicare Medical Review II (IRF)

Broadway Ventures LLC; United States, Northern America, Americas; Hybrid; USD 62,000 - 65,000; Full time

Benefits offered by this job

401(k) with company match

PTO grows with tenure

Life Insurance

Disability insurance

Job summary

Broadway Ventures is seeking a licensed Registered Nurse to perform complex medical review of Medicare claims for IRF services. This remote role requires timely PCR determinations and effective communication with providers.

The ideal candidate has 2–3 years of nursing experience, knowledge of CMS guidelines, and familiarity with claims review processes. Flexible remote work supports production-driven timelines and contract requirements.

Qualifications

• Active, unrestricted RN license in the United States.
• 2–3 years of clinical nursing experience (rehabilitation, acute care, or case management preferred).
• Prior Medicare medical review, utilization review, or claims review experience preferred.
• Strong knowledge of CMS guidelines, IRF criteria, and MAC review processes.
• Excellent written and verbal communication skills for provider interactions.

Responsibilities

• Review Medicare claims for IRF services per CMS guidelines.
• Perform PCR determinations within required timelines.
• Evaluate ADR responses and communicate determinations to providers.

Skills

Active RN license

2–3 years nursing

Medicare medical review

CMS guidelines knowledge

Communication skills

MS Office proficiency

Claims/medical review software

Tools

MS Office

Claims software

Job description

Broadway Ventures is seeking a licensed Registered Nurse to perform complex medical review of Medicare claims for IRF services. This remote role requires timely PCR determinations and effective communication with providers.

The ideal candidate has 2–3 years of nursing experience, knowledge of CMS guidelines, and familiarity with claims review processes. Flexible remote work supports production-driven timelines and contract requirements.