Medicaid Nurse Reviewer Team Lead - Remote

Peraton; Herndon (VA); Remote; USD 80,000 - 128,000; Full time

Job summary

Peraton is seeking a Nurse Reviewer Team Lead to oversee Medicaid medical reviews and guide a professional team. You will monitor quality, manage workload, and mentor staff while coordinating with investigations and subcontractors to support fraud investigations and referrals.

The role requires nursing licensure, strong investigative and regulatory skills, and the ability to work remotely from anywhere in the United States with occasional court appearances as needed.

Qualifications

• Minimum of 8 years with BS/BA or 12 years with a HS Diploma/equivalent.
• Experience in the medical review field as a fraud, waste, and abuse Nurse or clinician.
• Current and active nursing license.
• Strong investigative, communication, and organizational skills.
• Ability to apply Federal, State and MCO regulations to reviewed claims.
• Strong PC knowledge and skills; US citizenship required.
• Experience in reviewing claims and knowledge of Medicaid requirements.

Responsibilities

• Achieve quality objectives and oversee workload to promote timely medical reviews.
• Mentor team members and provide guidance to reviewers.
• Present issues of concern with regulatory violations or fraud allegations.
• Coordinate with Medicaid management and subcontractors; prepare review packages for peer reviews.
• Telework available from anywhere in the United States; oversee case tracker and workflow.

Skills

Investigative skills

Nursing license

Communication skills

Regulatory knowledge

PC skills

US citizenship

Claims review experience

Medicaid knowledge

Education

8+ years with BS/BA

12+ years with HS diploma

CPC certification

Job description

Peraton is seeking a Nurse Reviewer Team Lead to oversee Medicaid medical reviews and guide a professional team. You will monitor quality, manage workload, and mentor staff while coordinating with investigations and subcontractors to support fraud investigations and referrals.

The role requires nursing licensure, strong investigative and regulatory skills, and the ability to work remotely from anywhere in the United States with occasional court appearances as needed.