Medical Review Nurse

The role

The Medical Review Nurse will ensure durable medical equipment orders are compliant with CMS regulations. This role involves reviewing medical records and communicating findings to healthcare providers.

What you will do

• Review DMEPOS orders, progress notes, and medical records against coverage policies.
• Confirm medical necessity across diverse DME categories.
• Communicate findings to healthcare providers and internal teams.
• Educate stakeholders on evolving coverage criteria.
• Maintain strict compliance with HIPAA.
• Enforce disciplined handling of Protected Health Information.

Required qualifications

• 3 - 5+ years experience with DME pre-authorizations, DME utilization management reviews and/or DME claim audit processes.
• Standard computer literacy.
• Proficiency with medical review software/EHR platforms.
• Excellent written and verbal communication skills.
• Ability to thrive in a fast-paced environment with a flexible, adaptable mindset.
• Strong team player with a highly collaborative work style.
• Strict adherence to PHI guidelines and patient privacy protocols.

Nice to have

• Familiarity with InterQual and/or MCG review criteria.
• Experience in reviewing specific DME claims, including Surgical Dressings, CGMs, Insulin Pumps, Wound Care, Ostomy, Urology, CPAP/PAP therapy.

About the company

Verse Medical is a Series C company building software infrastructure to connect providers, payors, and patients for at-home care.