versemedical - Medical Review Nurse

• 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. • OUR PLEDGE FOR AN EQUITABLE FUTURE