Remote Nurse Review Team Lead (Fraud & Medical)

Peraton; Herndon (VA); Remote; USD 77,000 - 128,000; Full time

Benefits offered by this job

Telework from anywhere in the United S

Job summary

Peraton is a next-generation national security company that drives missions of consequence worldwide. As Nurse Reviewer Team Lead you will mentor the medical review team, oversee workloads, and ensure timely development and resolution of medical reviews.

You will research medical claims data, identify issues, and support fraud investigations with a range of tools. Telework is available from anywhere in the United States; salary range is $80,000 to $128,000, with potential overtime and a

Qualifications

• Minimum 8 years with BS/BA (12 years with HS Diploma or equivalent).
• Experience in medical review as a fraud/waste/abuse clinician.
• Current and active nursing license.
• Strong investigative, communication, and organizational skills.
• Applicant must be a U.S. citizen.

Responsibilities

• Achieve quality objectives and oversee workload for timely medical reviews.
• Mentor medical review team and provide guidance.
• Investigate medical claims data to identify fraud and support investigations.
• Present issues of concern citing regulatory violations.
• Make claim payment decisions based on clinical knowledge.
• Telework available from anywhere in the United States.

Skills

Investigative skills

Communication skills

Organizational skills

PC literacy

Education

BS/BA required

Tools

CPC (Certified Professional Coder)

Job description

Peraton is a next-generation national security company that drives missions of consequence worldwide. As Nurse Reviewer Team Lead you will mentor the medical review team, oversee workloads, and ensure timely development and resolution of medical reviews.

You will research medical claims data, identify issues, and support fraud investigations with a range of tools. Telework is available from anywhere in the United States; salary range is $80,000 to $128,000, with potential overtime and a