Remote Appeals Nurse ID-18148

June 11, 2025

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 providerwe're your trusted partner in innovation.

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Conduct first-level appeal reviews to assess the medical necessity and compliance of services with Medicare guidelines
Use clinical knowledge and professional judgment to evaluate claim documentation
Write concise, well-supported explanations for decisions regarding claims
Collaborate with internal team members to ensure appeal decisions are completed accurately and within expected timelines
Identify high-volume or recurring issues and escalate findings to leadership
Participate in quality improvement initiatives and contribute to consistent review practices

Minimum Qualifications

Associate's (ASN) or Bachelor's (BSN) Degree in Nursing
Active, unrestricted RN license in your state of residence/practice
U.S. residency for at least 3 of the last 5 years
Willingness to undergo and pass federal background screenings

Preferred Qualifications

4+ years of clinical nursing experience, including roles outside direct patient care
Experience in Medical Management, Medical Review, Utilization Review, or Appeals
Familiarity with Medicare Part A and Part B policies and procedures
Prior experience working in a remote environment
Previous work with a Medicare Administrative Contractor (MAC) is a plus
Strong technical writing and communication skills
Proficiency with Microsoft Office tools (Outlook, Teams, OneNote, Word, Excel) and ability to manage multiple online systems

Remote Work Requirements

A private, dedicated home workstation
Wired Ethernet internet connection (satellite internet and mobile hotspots not permitted)
Internet speed of at least 10 Mbps download / 1 Mbps upload (testable at speedtest.net)

Work Hours and Training

Regular work schedule falls between 6:00 AM Ã¢?? 6:00 PM Central, Monday through Friday
Training is typically conducted Monday through Friday, 8:00 AM Ã¢?? 4:00 PM Central, though times may vary slightly

What To Expect Next

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and discuss salary requirements. Management will be conducting interviews with the most qualified candidates. We perform a background and drug test prior to the start of every new hires' employment. In addition, some positions may also require fingerprinting.

Broadway Ventures is an equal-opportunity employer and a VEVRAA Federal Contractor committed to providing a workplace free from harassment and discrimination. We celebrate the unique differences of our employees because they drive curiosity, innovation, and the success of our business. We do not discriminate based on military status, race, religion, color, national origin, gender, age, marital status, veteran status, disability, or any other status protected by the laws or regulations in the locations where we operate. Accommodations are available for applicants with disabilities.

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