Medical Review Nurse

Verse Medical
United States
Workplace: RemoteFull timeUSD 80,000 - 90,000 annuallyFunction: Healthcare (Clinical, Medical, Wellness)Skills: ["Communication","Collaboration","Adaptability","Compliance","Attention to privacy"]

Ensure durable medical equipment (DME) orders are compliant with CMS regulations by reviewing medical necessity across DME categories and comparing orders, progress notes, and records against coverage policies. Partner with providers and internal teams to close documentation gaps and communicate policy-driven findings. Maintain HIPAA-compliant handling of PHI while supporting high billing quality and operational excellence in at-home care.

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FursaFursa
Verse Medical
Verse Medical
15 hours ago

Medical Review Nurse

✓ Verified Job

Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI
Last checked: 3 hours agoStatus: Live
Reposted: similar role first listed 2 months ago

Job Summary

Ensure durable medical equipment (DME) orders are compliant with CMS regulations by reviewing medical necessity across DME categories and comparing orders, progress notes, and records against coverage policies. Partner with providers and internal teams to close documentation gaps and communicate policy-driven findings. Maintain HIPAA-compliant handling of PHI while supporting high billing quality and operational excellence in at-home care.
Location: United States
Workplace: Remote
Employment Type: Full time
Job Function: Healthcare (Clinical, Medical, Wellness)
Seniority: Mid level

Key Responsibilities

  • •Review DMEPOS orders, progress notes, and medical records against coverage policies to confirm medical necessity across DME categories.
  • •Communicate review findings with healthcare providers and internal teams to bridge documentation gaps.
  • •Educate stakeholders on evolving coverage criteria based on medical necessity and policy requirements.
  • •Maintain strict HIPAA compliance and disciplined handling of Protected Health Information (PHI) across workflows.
  • •Support compliance integrity and billing quality through operational excellence in at-home care.

Pay and Benefits

Salary: USD 80,000 - 90,000 annually

Key Requirements

  • •3–5+ years of experience with DME pre-authorizations, DME utilization management reviews, and/or DME claim audit processes.
  • •Proficiency with medical review software and/or EHR platforms.
  • •Excellent written and verbal communication to explain complex policy requirements clearly.
  • •Ability to thrive in a fast-paced, flexible, adaptable environment.
  • •Strong collaboration with strict adherence to PHI and patient privacy protocols.
Experience:HealthcareDurable medical equipment (DME)Utilization management
Skills:CommunicationCollaborationAdaptabilityComplianceAttention to privacy
Tech Stack:EHRMedical review softwareHIPAAPHI

Company Brief

Verse Medical
Develops medical devices and related technologies aimed at improving clinical procedures and patient outcomes. Focuses on designing, prototyping, and bringing healthcare hardware solutions to market for use in hospitals and clinical settings.
Industry: Medical Devices
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