Remote Nurse Review Team Lead (Fraud & Medical)
$80k - $128kPeraton
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
#J-18808-Ljbffr- ...Peraton is seeking a Nurse Reviewer Team Lead for SafeGuard Services to oversee medical reviews, ensure quality, mentor staff, and... ...findings and support proactive fraud detection. The role requires an... ..., and the flexibility to work remotely from anywhere in the United States...Remote workMedicalFraud
- ...CoventBridge Integrity Systems is seeking a Medicaid Medical Review RN (Medical Reviewer III) for a remote role, based from Grove City, OH. The position conducts clinical reviews of medical records for fraud investigations and applies Medicare/Medicaid guidelines to determine...Remote workMedicalFraud
- ...CoventBridge Integrity Systems is seeking a Medicaid Medical Review RN (Medical Reviewer III) to conduct clinical chart reviews for fraud investigations and program integrity... ...payment coverage. This position is remote, with occasional on-site audits in OH if needed...Remote workMedicalFraud
- ...SafeGuard Services (SGS), a subsidiary of Peraton, seeks a Nurse Reviewer to conduct medical record reviews and apply clinical judgment to payment... ...research claims data, identify issues, and help develop fraud investigations. Travel for meetings and court appearances...Remote workMedicalFraud
- ...Seeking an experienced Registered Nurse Medical Reviewer, the full-time remote position will manage the medical review of complex claims, pre-authorization requests, appeals, and fraud referrals, applying clinical expertise to determine medical necessity and support accurate...Remote workMedicalFraudFull time
- ...Peraton is seeking a Medical Reviewer to join the SafeGuard Services team. The role involves conducting medical record... ...to identify issues and potential fraud. Telework is available from the contiguous... ...a clinical background, active nursing or therapy license, strong...Remote workMedicalFraud
$80k - $128k
Medical Review Team Lead - Medicaid Job Locations US Requisition ID 2026-171279 Position Category Business Controls... ...deter, reduce, and make referrals to recover fraud, waste, and abuse. We are looking to add a Nurse Reviewer Team Lead to our SGS team of talented...Remote workMedicalFraudContract workFor contractorsFor subcontractorWork at officeShift workNight shift- ...interested in joining a team of experienced... ...services. Benefits ~ Medical, dental, vision, life and... ...Statement The Clinical Review Nurse is responsible for reviewing... ...surfacing potential fraud and abuse or practice... ...opportunity is open to remote work in the following approved...Remote workMedicalFraudPermanent employmentTemporary workWork at officeLocal areaImmediate start
- ...Description: Title: Nurse Reviewer, Utilization... ...Brighton, MA office; 1 day remote FLSA Status: Exempt... ...concurrent, and retrospective medical necessity review of... ...and internal teams, and escalates cases requiring... ...and potential fraud, waste, and abuse per...Remote workMedicalFraudFull timeLocal area
$29 - $52 per hour
...performing compliance reviews of medical and administrative documentation... ...of healthcare fraud and/or wasteful and... ...schedule.This position is Remote in Massachusetts. You... ...with a team of 2-5 auditors to complete... ...term care, for example, nursing facility care delivery...Remote workMedicalFraudHourly payMinimum wageFull timeContract workWork experience placementLive inLocal areaMonday to FridayShift work- ...Clinical Review Nurse - Remote ARC Group has multiple positions... ...diverse perspectives lead to better innovation and... ...reviewing and making medical determinations as to the... ...guidance to other team members and accurately... ...includes surfacing potential fraud and abuse or practice...Remote jobMedicalFraudPermanent employmentWork at officeLocal area
$78k - $85k
Overview Medicaid Medical Review RN (Medical Reviewer III) - REMOTE The Medicaid Medical Review RN (Medical Reviewer... ...medical records during the course of fraud investigations or other program... ...audits are part of the role as a nurse reviewer Educational/Experience Qualifications...Remote workMedicalFraudFor contractorsH1bH2bWork at officeLocal areaHome office- ...Are you a bedside nurse seeking a change from... ...will : Review Nurse, Elderly and... ...-disciplinary work team, is responsible for the complete medical review and appropriate... ...suspected cases of fraud and abuse (e.g., upcoding... ...be conducted in remote or field locations....Remote workMedicalFraudContract workTemporary workWork at officeFlexible hours
$112.2k - $196.4k
...experienced Ecology/Waters Team Lead join our growing... ...QC) system, including reviewing work products and identifying... ...benefits such as medical, dental, vision, paid... ...more about recruitment fraud and how to report it,... ...IN, Indianapolis; US - Remote (Any Location)Type:...Remote workMedicalFraudFull timeWork at officeLocal areaFlexible hours- ...Massachusetts Licensed Clinical Review Specialist will conduct... ...confirm patient coverage, working remotely with a schedule of Monday to Friday... ...Required qualifications: Medical Assistant certification is required... ...knowledge of federal/state fraud and abuse laws is required...Remote workMedicalFraudFull timeMonday to Friday
- ...Guidehealth is seeking a Utilization Management Registered Nurse (RN) for a fully remote, full-time position. The role involves applying medical necessity criteria to reviews, documenting findings, and interfacing with providers and members to ensure timely, compliant...Remote workMedicalFull time
- ...Supplemental Products Team Lead (Health Insurance) Join... ...analysts as well as reviewing, analyzing, and auditing... ...to supplemental medical plans and benefits. Analyze... ...investigating potential fraud or discrepancies. Make... ...). Work Schedule & Remote Work Full-time, remote...Remote workMedicalFraudFull timeWork at officeWork from homeHome office
- ...Title Registered Nurse (RN) Expert Medical Examination Consultant... ...integrity and medical review initiatives in a full... ...schedule (three days remote, two days onsite).... ...potential indicators of fraud, waste, abuse, or... ...collaboration with compliance teams, investigators,...Remote workMedicalFraudLong term contractFull timeContract work
- ...New England Life Care currently has a Remote Clinical Review Specialist opportunity available. This... ...in conjunction with established medical criteria, members’ eligibility and benefit... ...Working knowledge of federal / state fraud and abuse laws required Knowledge of...Remote workMedicalFraudTemporary workLive inLocal areaMonday to Friday
- ...Partners is seeking an RN Utilization Review quality professional to lead QA efforts within the VUR team. You will mentor staff,... ...least three years of acute care nursing experience, and knowledge of medical necessity review criteria. Remote work with travel to client sites...Remote jobMedical
- ...Job Summary: The Team Leader is responsible... ...accuracy.The Team Lead of On-site UM is... ...that all RN Clinical Nurses are licensed, knowledgeable... ...compliance. Unlike remote roles, this... ...documentation does not support medical necessity or the... ...Medical Necessity Reviews: Use criteria like...Remote workMedicalFull timeImmediate startShift work
$66k - $106k
...galaxy. As the world’s leading mission capability integrator... ..., investigation, and medical review to detect, prevent,... ...make referrals to recover fraud, waste, and abuse. We... ...Reviewer to our SGS team of talented professionals... ...field as a Registered Nurse or other clinician, and...Remote workMedicalFraudContract workTemporary workShift workNight shift- ...Marketing Specialist - Team LeadAbout Quest... ...Analytics is a leading healthcare technology... ...choose between remote, hybrid or in-office... ...employee medical, dental and vision... ...unavailableRECRUITMENT FRAUD ALERTWe understand... ...process, such as reviewing applications, analyzing...Remote workMedicalFraudFull timeFor contractorsWork at officeImmediate startRelocationFlexible hours
$80k - $85k
...Flex Nurse EducatorIQVIA, the world... ...care through both remote and, when... ...education, including medication administration... ...mentoring new team members as needed... ...subject to a review of their driving... ....IQVIA is a leading global provider... ...for candidate fraud. All information...Remote workMedicalFraudFull timePart timeImmediate startWorldwideMonday to FridayFlexible hoursWeekend work- ...Registered Nurse (RN) | Med/Surg / Telemetry Location: Burlington... ...Title Registered Nurse – Medical Surgical / Telemetry... ...patient population Perform remote telemetry monitoring; on-unit... ...schools on the Florida Diploma Fraud Audit list will not be accepted...Remote workMedicalFraudWeekly payFull timeContract workImmediate startNight shiftWeekend work
$80k - $85k
...Flex Nurse EducatorIQVIA, the world... ...care through both remote and, when... ...education, including medication administration... ...mentoring new team members as needed... ...subject to a review of their driving... ...is a leading global provider... ...for candidate fraud. All information...Remote workMedicalFraudFull timePart timeImmediate startWorldwideMonday to FridayFlexible hoursWeekend workAfternoon shift$64.5k - $92.2k
Gainwell Technologies LLC is seeking a Clinical Quality Nurse Reviewer, Sr. Specialist for a remote role. You will conduct quality assurance audits of clinical staff's work and ensure compliance with medical records and guidelines. The position requires an active RN license...Remote workMedical$80k - $85k
...Flex Nurse EducatorIQVIA, the world... ...care through both remote and, when... ...education, including medication administration... ...mentoring new team members as needed... ...subject to a review of their driving... ....IQVIA is a leading global provider... ...for candidate fraud. All information...Remote workMedicalFraudFull timePart timeImmediate startWorldwideMonday to FridayFlexible hoursWeekend workAfternoon shift- ...service and post-service utilization reviews and appeals within a NCQA-... ...UM program, collaborating with our Medical Director. The role emphasizes applying... ..., referrals, and handling appeals. Remote opportunities available and strong team culture. #J-18808-LjbffrRemote workMedical
- ...perform pre-service and post-service utilization reviews and appeals for DMEPOS. You will collaborate with our Medical Director to ensure benefit and medical necessity... ...CMS guidelines. The role supports a nationwide remote workforce with competitive compensation, benefits...Remote workMedical
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