Remote Appeals Nurse

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.

Broadway Ventures, LLC is seeking a Remote Appeals Nurse (RN) to join our growing team. In this fully remote role, you will review medical records and claims to determine whether services meet Medicare coverage and medical necessity requirements. This role is ideal for a detail-oriented and experienced nurse who excels in documentation review and is passionate about ensuring accurate and fair healthcare adjudication.

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