Medical Review Nurse

The healthcare industry still relies on faxes and phone tags to coordinate critical care for patients at home. We think patients and the clinicians who serve them deserve better than a system stuck in 1995.

Verse Medical is building the modern software infrastructure to make it happen. We're a well-funded Series C company (backed by General Catalyst, SignalFire, and Sapphire Ventures) on a mission to heal a fragmented system. Our platform connects the dots between providers, payors, and patients, ensuring people get the high-quality care they need, reliably and right where they live. We’re growing fast and looking for people who are driven by this mission to join us!

Our values are the operating system for how we work together and with our partners. They aren't just words on a wall; they are the principles we bring to every decision, every day.

This isn't just a job; it's an opportunity to build something that truly matters and directly shape the future of at-home care. As our Medical Reviewer, you will play a critical, hands-on role in ensuring that every durable medical equipment (DME) order is fully compliant with Centers for Medicare & Medicaid Services (CMS) regulations, including Local Coverage Determinations (LCDs), and Local Coverage Articles (LCAs) You will serve as the bridge between complex policy requirements and operational excellence, directly safeguarding our compliance integrity and billing quality.

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• Prior experience (3 - 5+ years) with DME pre-authorizations, DME utilization management reviews and/or DME claim audit processes.

• Standard computer literacy and proficiency with medical review software/EHR platforms.

• Excellent written and verbal communication skills with the ability to convey complex policy requirements clearly.

• Proven 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.

• 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.

At Verse Medical, our mission is to deliver equitable, hospital-quality care to everyone, regardless of their background or where they live. We can only achieve this if our own team reflects the diversity of the patients we serve. We are committed to building a workplace where everyone feels a sense of belonging, where their contributions are valued, and where they can do their best work. We embrace diversity of all kinds: race, gender, age, religion, identity, experience. We are actively working to build a more inclusive and equitable world, starting from within our own walls. We are an equal opportunity employer.

We are also committed to providing a positive and accessible interview experience. If you require any accommodations to participate in our process, please contact us at recruiting@versemedical.com.