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← Broadway Ventures

Medical Review II (Medicare)

Broadway Ventures
Location
United States
Posted
25 days ago
Department
Medical Services
Salary
$62,000-$65,000
What they actually want (must-haves)
  • Active, unrestricted Registered Nurse (RN) license; compact license preferred
  • Minimum of 2–3 years of clinical nursing experience
  • Prior experience in Medicare medical review, utilization review, or claims review
  • Working knowledge of CMS coverage guidelines and IRF medical necessity criteria
  • Strong analytical and clinical decision-making skills
  • Excellent written and verbal communication skills
Nice to have
  • Direct experience with Inpatient Rehabilitation Facility (IRF) documentation and CMS Review Choice Demonstration (RCD) programs
  • Certification in case management, utilization review, or a related specialty
What the job really is

In this remote role, the Medical Review II will be responsible for performing complex medical reviews of Medicare claims specifically for Inpatient Rehabilitation Facility (IRF) services. The position involves conducting pre-claim reviews, evaluating documentation requests, and communicating determinations to healthcare providers while adhering to strict deadlines and regulatory guidelines.

Benefits
  • 401(k) and company match
  • PTO that grows the longer you stay
  • Health, Vision, Dental
  • Company provided Life Insurance and Voluntary Life Insurance
  • Short Term Disability and Long Term Disability
Things to weigh
  • Pay range provided is not a guarantee and depends on various factors
  • Position contingent upon contract award for some postings
  • Work is production-driven with strict turnaround requirements
Job score4/5
Benefits3/5
Freshness4/5
Career value4/5
Role clarity4/5
Pay transparency5/5

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