Medical Review Nurse

About the Company

Verse Medical is building the modern software infrastructure to coordinate critical care for patients at home. A well-funded Series C company, we connect providers, payors, and patients to ensure high-quality care is delivered reliably where people live.

Responsibilities

• Interpret and operationalize LCD L33831 and Policy Articles for surgical dressings into practical rules.
• Establish "go/no-go" criteria for various dressing types and codify modifier usage and sizing math.
• Build and pilot a two-gate QA process for clinical completeness and billing correctness.
• Lead UPIC/MAC ADR responses and establish a reusable appeals library.
• Train customer-facing teams and billers on documentation requirements that satisfy LCDs.
• Define and track metrics including denial percentages, appeal win rates, and ADR turnaround.

Requirements

• 3-5+ years of medical-review experience at a UPIC or MAC.
• Hands-on adjudication experience with surgical dressings (collagen, alginate, foam, film, etc.).
• Expertise in proof-of-delivery standards, SWO requirements, and frequency/sizing rules.
• Strong policy-anchored writing skills.
• Ability to work calmly under deadlines and maintain discipline with PHI.