Medical Review Nurse – At‑Home Care Compliance

About the role

Verse Medical is seeking a Medical Review Nurse to help modernize at‑home care. In this role you will ensure that every surgical dressing order complies with CMS regulations and internal policies, translating complex guidelines into actionable checklists.

Key responsibilities

• Interpret and operationalize LCD L33831 and related policy articles for surgical dressings.
• Publish practical coverage rules, including go/no‑go criteria for various dressing types.
• Develop and pilot a two‑gate quality assurance process covering clinical completeness and billing correctness.
• Identify and correct packet defects before billing and manage ADRs/appeals processes.
• Collaborate with cross‑functional teams to codify modifiers, sizing, and frequency calculations.

Required profile

• Registered Nurse with experience in medical review, coding, or compliance.
• Strong knowledge of CMS regulations, MAC and UPIC policies.
• Detail‑oriented with the ability to translate regulatory language into clear operational guidelines.
• Excellent analytical skills and comfort working with complex documentation.

Required skills

• Understanding of LCDs and MAC playbooks.
• Experience with clinical and billing quality assurance processes.
• Familiarity with surgical dressing products and related coding modifiers.