Medical Review Nurse

Verse Medical

🇬🇧 English

Job description

About the role

Verse Medical is seeking a Medical Review Nurse to help shape the future of at‑home care. In this role you will ensure surgical dressing orders meet all CMS regulations and translate complex policy guidance into practical, actionable checklists.

Key responsibilities

Interpret and operationalize LCD L33831 and related policy articles for surgical dressings.
Publish practical rules covering coverage, limits, and documentation phrasing.
Establish go/no‑go criteria for various dressing types and codify modifier usage.
Build and pilot a two‑gate QA process for clinical completeness and billing correctness.
Identify and fix packet defects before billing.
Run ADRs and appeals processes to ensure compliance.
Maintain alignment with CMS regulations, MACs, and UPICs.

Required profile

Strong knowledge of CMS regulations and MAC/UPIC policies.
Experience translating policy documents into operational checklists.
Detail‑oriented with a focus on compliance and accuracy.
Ability to work in a fast‑moving, mission‑driven environment.

Required skills

Questions fréquentes

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Published 2 months ago

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