Nurse Reviewer Team Lead - Remote

Peraton; United States; Remote; USD 90,000 - 130,000; Full time

Benefits offered by this job

Telework from anywhere in the United (

Job summary

SafeGuard Services, a Peraton subsidiary, seeks a Nurse Reviewer Team Lead to oversee medical review for fraud, waste, and abuse. You will mentor the team, guide investigations, and ensure timely, high-quality referrals to law enforcement or other entities.

Responsibilities include maintaining quality objectives, coordinating workload, mentoring staff, and presenting regulatory concerns. Telework is available nationwide, with court testimony possible as part of the role.

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 other clinician, and/or experience in review of medical claims for coverage and medical necessity.
• Current and active nursing license
• Strong investigative skills
• Strong communication and organization skills
• Strong PC knowledge and skills
• Applicant must be a U.S citizen
• Spanish Speaking and Writing

Responsibilities

• This position may require the incumbent to appear in court to testify about work findings.
• Ability to compose correspondence, reports, and referral summary letters.
• Ability to communicate effectively, internally and externally
• Ability to handle confidential material.
• Ability to report work activity on a timely basis.
• Ability to work independently and as a member of a team to deliver high quality work
• Ability to attend meetings, training, and conferences, overnight travel required
• Coordinate with other designated leads if necessary, for coverage for periods where the lead is out of the office during work hours.
• Ability to educate providers, provider associations, law enforcement, other contractors and beneficiary advocacy groups on program safeguard matters
• Ability to perform research and draw conclusions
• Ability to present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government
• Telework available from anywhere in the United States

Skills

Investigative skills

Communication

Organization

Nursing knowledge

U.S. citizen

Spanish language skills

Proficiency with PCs

Education

BS/BA or higher in Nursing/related field

HS Diploma/equivalent with 12 years experience

CPC Certification

Tools

Medical claims data review tools

Job description

SafeGuard Services, a Peraton subsidiary, seeks a Nurse Reviewer Team Lead to oversee medical review for fraud, waste, and abuse. You will mentor the team, guide investigations, and ensure timely, high-quality referrals to law enforcement or other entities.

Responsibilities include maintaining quality objectives, coordinating workload, mentoring staff, and presenting regulatory concerns. Telework is available nationwide, with court testimony possible as part of the role.