Remote Nurse Reviewer Team Lead

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

Benefits offered by this job

Telework from anywhere in the United S

Job summary

Peraton is seeking a Nurse Reviewer Team Lead to guide a medical review team within SafeGuard Services, ensuring timely, accurate review of medical claims and referrals for investigations. The role demands clinical expertise, strong communication, and leadership to mentor staff and coordinate with investigators.

The position requires a nursing license, 8+ years with a BS/BA or 12+ years with a HS diploma, and US citizenship. Telework from anywhere in the United States is available.

Qualifications

• Active nursing license required.
• 8+ years with BS/BA or 12+ years with HS diploma/equivalent.
• Strong investigative and analytical capabilities in medical claims.
• Excellent communication and organizational abilities.

Responsibilities

• Lead quality objectives and oversee workload to ensure timely medical reviews.
• Mentor and guide the medical review team; develop case referrals with investigations.
• Present issues of concern with regulatory context and potential fraud indicators.
• Make claim payment decisions based on clinical knowledge and supporting data.
• Coordinate with investigators and other leads; travel may be required.

Skills

Nursing license

Investigative skills

Communication skills

Organizational skills

US citizenship

Education

BS/BA in nursing or related field

HS Diploma

Job description

Peraton is seeking a Nurse Reviewer Team Lead to guide a medical review team within SafeGuard Services, ensuring timely, accurate review of medical claims and referrals for investigations. The role demands clinical expertise, strong communication, and leadership to mentor staff and coordinate with investigators.

The position requires a nursing license, 8+ years with a BS/BA or 12+ years with a HS diploma, and US citizenship. Telework from anywhere in the United States is available.