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About The Role:
- Conducting pre- and post-payment medical reviews
- Assess medical necessity, appropriateness, and reimbursement eligibility
- Documenting decisions in accordance with regulatory and organizational requirements
Key Responsibilities:
- Educate internal and external teams on medical review processes
- Support quality control activities
- Assist with special projects
Minimum Qualifications:
- Active, unrestricted RN license
- Associate Degree in Nursing OR Graduate of an accredited School of Nursing
- Two years of clinical experience
Broadway Ventures
Broadway Ventures transforms 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), they empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth.