Sign up to access all features of our service.
  • Job search
  • Favorites
  • Create a CV
    New
  • Salaries
  • Subscriptions

Remote Nurse Review Team Lead (Fraud & Medical)

$80k - $128k

Peraton

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
Vacancy posted 17 hours ago
Similar jobs that could be interesting for youBased on the Remote Nurse Review Team Lead (Fraud & Medical) in United States vacancy
  •  ...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 work
    Medical
    Fraud

    Peraton

    Brooklyn, NY
    3 days ago
  •  ...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 work
    Medical
    Fraud

    CoventBridge Integrity Systems

    Grove City, OH
    19 hours ago
  •  ...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 work
    Medical
    Fraud

    CoventBridge Integrity Systems

    New York, NY
    1 hour ago
  •  ...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 work
    Medical
    Fraud

    Peraton

    Arlington, TX
    16 hours ago
  •  ...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 work
    Medical
    Fraud
    Full time

    Virtual Vocations Inc

    United States
    15 hours ago
  •  ...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 work
    Medical
    Fraud

    Peraton

    New York, NY
    19 hours ago
  • $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 work
    Medical
    Fraud
    Contract work
    For contractors
    For subcontractor
    Work at office
    Shift work
    Night shift

    Peraton

    Herndon, VA
    22 hours ago
  •  ...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 work
    Medical
    Fraud
    Permanent employment
    Temporary work
    Work at office
    Local area
    Immediate start

    Novitas Solutions

    United States
    1 day ago
  •  ...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 work
    Medical
    Fraud
    Full time
    Local area

    BrightonONE

    Brighton, MA
    9 days ago
  • $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 work
    Medical
    Fraud
    Hourly pay
    Minimum wage
    Full time
    Contract work
    Work experience placement
    Live in
    Local area
    Monday to Friday
    Shift work

    Genoa Telepsychiatry

    United States
    3 days ago
  •  ...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 job
    Medical
    Fraud
    Permanent employment
    Work at office
    Local area

    American Recruiting & Consulting Group

    Jacksonville, FL
    3 days ago
  • $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 work
    Medical
    Fraud
    For contractors
    H1b
    H2b
    Work at office
    Local area
    Home office

    CoventBridge Integrity Systems

    Grove City, OH
    2 days ago
  •  ...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 work
    Medical
    Fraud
    Contract work
    Temporary work
    Work at office
    Flexible hours

    Alliant Health Solutions, Inc.

    Atlanta, GA
    3 days ago
  • $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 work
    Medical
    Fraud
    Full time
    Work at office
    Local area
    Flexible hours

    Parsons

    Indianapolis, IN
    6 days ago
  •  ...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 work
    Medical
    Fraud
    Full time
    Monday to Friday

    Virtual Vocations Inc

    United States
    16 hours ago
  •  ...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 work
    Medical
    Full time

    Guidehealth

    United States
    4 days ago
  •  ...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 work
    Medical
    Fraud
    Full time
    Work at office
    Work from home
    Home office

    Tres Health

    New York, NY
    3 days ago
  •  ...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 work
    Medical
    Fraud
    Long term contract
    Full time
    Contract work

    The CKHobbie Group

    Harrisburg, PA
    4 days ago
  •  ...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 work
    Medical
    Fraud
    Temporary work
    Live in
    Local area
    Monday to Friday

    New England Life Care

    Salem, NH
    3 days ago
  •  ...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 job
    Medical

    Ensemble Health Partners

    Columbus, OH
    2 days ago
  •  ...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 work
    Medical
    Full time
    Immediate start
    Shift work

    Wellstar Health Systems, Inc.

    Marietta, GA
    a month ago
  • $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 work
    Medical
    Fraud
    Contract work
    Temporary work
    Shift work
    Night shift

    Peraton

    New York, NY
    18 hours ago
  •  ...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 work
    Medical
    Fraud
    Full time
    For contractors
    Work at office
    Immediate start
    Relocation
    Flexible hours

    Quest Analytics

    Shawnee Mission, KS
    9 days ago
  • $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 work
    Medical
    Fraud
    Full time
    Part time
    Immediate start
    Worldwide
    Monday to Friday
    Flexible hours
    Weekend work

    IQVIA Holdings

    San Antonio, TX
    4 days ago
  •  ...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 work
    Medical
    Fraud
    Weekly pay
    Full time
    Contract work
    Immediate start
    Night shift
    Weekend work

    Concentric Healthcare Staffing

    Burlington, NC
    1 day ago
  • $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 work
    Medical
    Fraud
    Full time
    Part time
    Immediate start
    Worldwide
    Monday to Friday
    Flexible hours
    Weekend work
    Afternoon shift

    MCRA, LLC

    Corona, NY
    2 days ago
  • $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 work
    Medical

    Gainwell Technologies LLC

    Tetonia, ID
    4 days ago
  • $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 work
    Medical
    Fraud
    Full time
    Part time
    Immediate start
    Worldwide
    Monday to Friday
    Flexible hours
    Weekend work
    Afternoon shift

    IQVIA Holdings

    Atlanta, GA
    2 days ago
  •  ...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-Ljbffr
    Remote work
    Medical

    Integra Partners

    United States
    2 days ago
  •  ...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 work
    Medical

    Integra Partners

    United States
    2 days ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Remote Nurse Review Team Lead (Fraud & Medical). Be the first to apply!