Remote Nurse Reviewer Team Lead

Peraton; Chantilly (VA); Remote; USD 90,000 - 120,000; Full time

Benefits offered by this job

Telework available

Job summary

SafeGuard Services (SGS), a Peraton subsidiary, seeks a Nurse Reviewer Team Lead to guide medical reviews and fraud investigations within the SGS team. You will oversee workload, mentor staff, and coordinate with investigations to develop cases for referral to law enforcement or other entities.

You will analyze medical claims data, present findings, and ensure compliance with Federal, State, and MCO regulations while maintaining confidentiality and timely reporting.

Qualifications

• Minimum of 8 years with BS/BA or 12 years with HS Diploma/equivalent.
• Experience in the medical review field as fraud, waste, and abuse nurse or clinician, and/or review of medical claims for coverage and medical necessity.

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 for coverage for periods when 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

Education

BS/BA degree

Tools

Microsoft Office

Job description

SafeGuard Services (SGS), a Peraton subsidiary, seeks a Nurse Reviewer Team Lead to guide medical reviews and fraud investigations within the SGS team. You will oversee workload, mentor staff, and coordinate with investigations to develop cases for referral to law enforcement or other entities.

You will analyze medical claims data, present findings, and ensure compliance with Federal, State, and MCO regulations while maintaining confidentiality and timely reporting.