About the Role:
- Conduct pre- and post-payment medical reviews.
- Assess medical necessity and reimbursement eligibility.
- Document decisions in accordance with regulations.
Key Responsibilities:
- Provide clear rationales for service approvals or denials.
- Educate teams on medical review processes and coding requirements.
- Support quality control activities.
Minimum Qualifications:
- Active, unrestricted RN license in the U.S.
- Associate Degree in Nursing or accredited School of Nursing.
- Two years of clinical experience plus two years in Home Health Utilization/Medical Review or Quality Assurance.
Broadway Ventures
Broadway Ventures delivers tailored solutions that drive operational success, sustainability, and growth for government and private sector clients. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), they empower clients with expert program management, cutting-edge technology, and innovative consulting solutions.