DME Medical Reviewer
Broadway VenturesAt 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.
DME Medical Review
Requirements:
Subcontractor will provide medical claims review services by registered nurses.
• At a minimum, nurses shall hold active, unrestricted RN license from the United States and in the state of hire OR Active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC). CGS Administrators will perform periodic license checks during the period of performance.
• Required Education: Associate degree – Nursing; Graduate of an accredited School of Nursing
• Required Work Experience: 2 years clinical experience
• Subcontractor will ensure employees working from home are in compliance with Contractor’s work at home requirements.
Deliverables:
By the 15th of the following month, Subcontractor will submit a monthly summary report to the Contractor program managers. At a minimum, the report should cover:
• Summary of staffing by all positions. This would include how many staff are working on the subcontract, how many positions are being recruited and a summary of recruiting efforts, upcoming changes to staffing levels,
• Brief financial update including current subcontract spend compared to total amount on subcontract, any updates to planned spend rate, and other financial information that has the potential to impact subcontract,
• Any necessary updates specific to staff that would help Contractor plan for the coming weeks / months. This could include extended vacation for staff, changes to pay rates, planned termination dates, etc.
On a quarterly basis, Subcontractor leadership will schedule and conduct a “state of the state” meeting with the Contractor Program Managers, Medical Review leadership team, and Contractor’s small business liaison to discuss how current efforts are going and if any changes need to occur to ensure long term goal are achieved.
Performance Measures / Acceptance Criteria
All Subcontractor staff will be required to meet the same criteria as Contractor staff in the same role. Criteria generally include:
• Monthly quality audits
• Monthly productivity goals
• Adherence to accepted schedule
• Adherence to Contractor’s standard operating procedures
• Adherence to Contractor’s code of conduct
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.