Verse Medical
Medical Review Nurse
$80K–$90K
Remote · Remote · Full-time · Posted Sep 11, 2026
- Experience
- 3–5+ years; experience may be in DME pre-authorizations, DME utilization management reviews, and/or DME claim audit processes.
About the job
Reviews durable medical equipment orders and medical records for medical necessity and compliance with CMS coverage policies, while supporting provider education and protecting patient information.
What you'll do
- Review DMEPOS orders, progress notes, and medical records against coverage policies to confirm medical necessity.
- Communicate review findings and documentation gaps to providers and internal teams, and explain evolving coverage criteria.
- Follow HIPAA requirements and protect PHI across workflows.
What they ask for
- 3–5+ years of experience with DME pre-authorizations, DME utilization management reviews, and/or DME claim audit processes.
- Computer literacy and proficiency with medical review software or EHR platforms.
- Strong written and verbal communication skills to explain complex policy requirements.
- Adherence to PHI guidelines and patient privacy protocols.
Nice to have
- Familiarity with InterQual and/or MCG review criteria.
- Experience reviewing claims for specified DME categories, including surgical dressings, CGMs, insulin pumps, wound care, ostomy, urology, and CPAP/PAP therapy.
Pay
$80K – $90K
Tools
CMS, LCDs, LCAs, HIPAA, PHI, InterQual, MCG, EHR
Model-written summary · the original posting is authoritative