Medical Review Nurse
Job Summary
To support a growing healthcare platform, the full-time Medical Review Nurse will ensure compliance with CMS regulations for durable medical equipment orders, educate providers on coverage policies, and maintain data security while working remotely.
Key Responsibilities
- Review DMEPOS orders and medical records to confirm medical necessity against coverage policies
- Communicate findings to healthcare providers and internal teams to address documentation gaps
- Maintain compliance with HIPAA and ensure proper handling of Protected Health Information (PHI)
Required Qualifications
- 3-5+ years of experience with DME pre-authorizations, utilization management reviews, or claim audits
- Proficiency with medical review software and EHR platforms
- Ability to clearly convey complex policy requirements in written and verbal communication
- Experience thriving in fast-paced environments with a flexible mindset
- Strong collaborative skills and a commitment to patient privacy protocols
Complete Job Description
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