Senior Medical Reviewer

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

At Broadway 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 Range: $68,000 – 70,000 per annum
Start Date: November 2026

About Broadway Ventures

Broadway Ventures, LLC is a certified small business government contractor providing healthcare administration and IT services to federal agencies, including CMS, the VA, and DoD.

Position Summary

We are seeking an experienced Registered Nurse to directly supervise a team of RN Medical Reviewers supporting Medicare medical review operations. This role owns daily workload distribution and turnaround performance, ensures compliance with CMS and client security requirements, and serves as the first line of escalation for case risk, provider concerns, and integrity matters.

Key Responsibilities

• Directly supervise a team of approximately 20 RN Medical Reviewers, managing day-to-day case assignment and workload distribution
• Monitor case turnaround daily against the 7-business-day requirement, reviewing the case management system to identify cases approaching their due date and rebalancing workload to prevent bottlenecks
• Flag any case at risk of missing turnaround by day 5 of the 7-business-day window, reassigning to a reviewer with capacity or escalating to expedite completion
• Confirm and elevate provider concerns and complaints, suspected fraud, aberrant billing behavior, and data or privacy incidents to the client within required timeframes - one business day, or immediately for fraud and security matters
• Conduct periodic virtual desk audits of assigned RN Medical Reviewers' remote work environments to confirm compliance with CMS and client security and location requirements
• Mentor newly onboarded RN Medical Reviewers on client-furnished systems and procedures once approved for independent production
• Report turnaround performance and workload/staffing risk to the Project Manager daily

Minimum Qualifications

• Active, unrestricted, and unencumbered RN license (single-state or compact multistate)
• 5+ years of nursing experience, including 2+ years in Medicare medical review or utilization review (UR). Equivalent combinations of clinical and Medicare review experience will be considered.
• Strong documentation and independent decision-making skills, with the ability to oversee a reviewer caseload and workload distribution under strict deadlines
• Must reside and work from within the U.S., D.C., or a U.S. territory
• Private, secure home workspace meeting CMS security requirements

Preferred Qualifications

• Direct home health RCD or comparable MAC medical review experience
• Existing familiarity with home health pre-claim review documentation, including face-to-face encounter notes, comprehensive assessments, plans of care, certifications and recertifications, and homebound/medical necessity documentation
• Prior MAC, RCD, or CMS program integrity experience across multiple jurisdictions (e.g., Jurisdiction J/M)

Conditions of Employment

• RN license will be verified prior to assignment and monthly thereafter
• Must maintain a private, secure remote work environment meeting CMS security requirements, subject to periodic virtual desk audits

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 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

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.