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 7 hours ago
Similar jobs that could be interesting for youBased on the Remote Nurse Review Team Lead (Fraud & Medical) in Herndon, VA vacancy
  •  ...Disabled Waiver Program Review Nurse Are you a bedside nurse...  ...multi-disciplinary work team, is responsible for the complete medical review and appropriate...  ...documents suspected cases of fraud and abuse (e.g.,...  ...but may be conducted in remote or field locations. The... 
    Remote work
    Medical
    Fraud
    Contract work
    Temporary work
    Work at office
    Flexible hours

    Alliant Health Solutions

    Atlanta, GA
    2 days ago
  • $85.09k - $115k

     ...Location: Any Location / Remote Full Part/Time:...  ..., Documentation Review, Medical Billing and Coding...  ...Policy Review Nurse will contribute to...  ...AND PERSONAL IMPACT Lead the evaluation of...  ...coding/compliance teams, product teams, and...  ...against identity fraud. You are expected... 
    Remote work
    Medical
    Fraud
    Full time
    Temporary work
    Part time
    Immediate start
    Work from home
    Worldwide
    Flexible hours

    General Dynamics Corporation

    Falls Church, VA
    3 days 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

    Reston, VA
    7 hours ago
  • $51k - $82k

     ...analysis, investigation, and medical review to detect, prevent, deter,...  ...make referrals to recover fraud, waste, and abuse. We are looking to add a Nurse Reviewer to our SGS team of talented professionals....  ...the galaxy. As the world’s leading mission capability integrator... 
    Remote work
    Medical
    Fraud
    Contract work
    Shift work
    Night shift

    Peraton

    United States
    2 days ago
  •  ...We are looking for Medical Record Retrievers/Clinical Record Reviewers to support a need for...  ...: Primarily remote. Candidates are required...  ...state, OR Certified Nursing Assistant (CNA) or...  ...Excel, PowerPoint, Teams. Experience with any...  ...Recruiting Fraud Over the past year,... 
    Remote work
    Medical
    Fraud

    GeBBS Consulting

    Annapolis, MD
    6 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
    6 days ago
  • $29 - $52 per hour

     ...The Clinical Claim Review RN will be...  ...compliance reviews of medical and administrative...  ...instances of healthcare fraud and/or wasteful and...  ...This position is Remote in Massachusetts. You...  ...Collaborate with a team of 2-5 auditors to...  ...work experience ~ Nurse licensure (RN or... 
    Remote work
    Medical
    Fraud
    Hourly pay
    Minimum wage
    Full time
    Contract work
    Work experience placement
    Live in
    Local area
    Monday to Friday
    Shift work

    LeadingAge Virginia

    Boston, MA
    2 days ago
  •  ...straight to better care.? Requirements The Nurse Reviewer performs complex medical record reviews of Medicare Part A/B...  ...the potential for overpayment or fraud. Using established criteria/ and...  ...the essential functions. This is a remote position. While performing the duties... 
    Remote work
    Medical
    Fraud
    Contract work
    For contractors
    Local area

    Commence, LLC

    Brooklyn, NY
    5 days 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

    Chicago, IL
    7 hours ago
  •  ...you a registered nurse ready to take...  ...mission-driven team dedicated to improving...  ...setting to review and audit...  ...judgment to analyze medical records,...  ...Pennsylvania's leading Quality Improvement...  ...populations Remote work - enjoy the...  ...potential fraud, waste, or abuse... 
    Remote work
    Medical
    Fraud
    Full time
    Temporary work
    Work at office
    Work from home

    The CKHobbie Group

    Pittsburgh, PA
    5 days ago
  • $147.29k - $199.28k

     ...: GDIT seeks a Network Team Lead for our federal client...  ...offers a combination of remote work and periodic on-site...  ...includes a variety of medical plan options, some with...  .... We regularly review our Total Rewards package...  ...protect against identity fraud. You are expected to be... 
    Remote work
    Medical
    Fraud
    Full time
    Temporary work
    Part time
    Immediate start
    Worldwide
    Flexible hours

    General Dynamics

    Eastern, KY
    4 days ago
  • $95k - $107.5k

     ...Description Title: Nurse Reviewer Utilization Management...  ...MA office; 1 day remote FLSA Status: Exempt...  ...concurrent and retrospective medical necessity review of...  ...and internal teams and escalates cases requiring...  ...concerns and potential fraud waste and abuse per protocol... 
    Remote work
    Medical
    Fraud
    Full time
    Local area

    BrightonONE

    Boston, MA
    1 day 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
    5 days ago
  •  ...Registered Nurse – Utilization Review (Remote) Position Overview: This is a fully remote Utilization Review RN role supporting multiple service...  ...Required Qualifications: Minimum of 3 years acute medical Care Management/Utilization Review experience in a hospital... 
    Remote work
    Medical

    3B Healthcare, Inc.

    Torrance, CA
    2 days ago
  •  ...Pediatrics* ICU MS Case Management/Utilization Review Pre-Cert Review* Prior Authorizations*...  ...Review Continued Stay Reviews Determine Medical Necessity per Evidence-Based Guidelines...  ...Safety Goals Additional Skills Remote UR work CA and Medi-Cal experience/knowledge... 
    Remote work
    Medical

    B2B Staffing Services

    Torrance, CA
    2 days ago
  •  ...and experienced Registered Nurse with specialties in Medical/Surgical, ICU, ER, Psychiatric...  ...with the interdisciplinary team. Critical to this role is...  ...Experience in Utilization Review or case management roles....  ...ability to work independently in remote settings. Must be able... 
    Remote work
    Medical
    Flexible hours

    vTech Solution

    Santa Rosa, CA
    3 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
    7 hours ago
  •  ...Job Opportunity Review and evaluate the medical necessity, appropriateness, quality, quantity, adequacy...  ...the Medical Assistance Program. The nurse is responsible for the review and evaluation...  ...that the provider and/or recipient fraud, abuse, and waste is detected.... 
    Medical
    Fraud
    Work at office
    Long distance
    Night shift

    The CKHobbie Group

    Harrisburg, PA
    3 days ago
  • $1,600 - $1,800 per week

     ...Now Hiring: Registered Nurse – Utilization Management Location...  ...weekends, no holidays, no telehealth/remote work Minimum Qualifications...  ...Management, Utilization Review, or Case Management Preferred...  ..., Case Management, or Medical-Surgical (ANCC or NCQA) Required... 
    Remote work
    Medical
    Contract work
    Immediate start
    Monday to Friday

    J Edward Staffing LLC

    Aurora, CO
    2 days ago
  •  ...Nurse Auditor Have you ever looked a medical bill and immediately noticed something was wrong? Were you itching to use your expertise...  ...world of medical cost containment. Join our team and maximize client savings by reviewing medical bills from a nurse perspective,... 
    Remote work
    Medical
    Immediate start

    Rising Medical Solutions

    United States
    4 days ago
  • $80k - $85k

     ...Flex Nurse Educator - San Antonio E...  ...care through both remote and, when...  ...education, including medication administration...  .... Join IQVIA's team of over 10,000...  ...be subject to a review of their...  ...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

    San Antonio, TX
    6 days ago
  •  ...growing healthcare platform, the full-time Medical Review Nurse will ensure compliance with CMS...  ...and maintain data security while working remotely. Key Responsibilities Review DMEPOS orders...  ...to healthcare providers and internal teams to address documentation gaps Maintain... 
    Remote work
    Medical
    Full time
    Flexible hours

    Virtual Vocations Inc

    United States
    2 days ago
  • $80k - $85k

     ...Flex Nurse Educator - Atlanta W, GA...  ...care through both remote and, when...  ...education, including medication administration...  .... Join IQVIA's team of over 10,000...  ...be subject to a review of their...  ...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

    Columbus, GA
    5 days ago
  • $34 per hour

     ...The kozmetickesluzby.vecnakraska.sk - Jobboard is seeking a Sr. Medical Review Nurse for a remote position based in Baltimore, MD. This role involves comprehensive reviewing of medical records, coding practices, and working with stakeholders to ensure compliance and accuracy... 
    Remote work
    Medical
    Hourly pay
    Full time

    kozmetickesluzby.vecnakraska.sk - Jobboard

    Baltimore, MD
    7 hours ago
  • Itemized Bill and Medical Record Reviewer job at Alaffia Health. New York, NY. About...  ...due to medical billing fraud, waste, and administrative burden...  ...that. We’ve assembled a team of clinicians, AI/ML engineers...  ...access to Leadership LI-REMOTE #J-18808-Ljbffr Alaffia Health
    Remote work
    Medical
    Fraud
    Flexible hours

    Alaffia Health

    New York, NY
    6 days ago
  • $1,946.5 per month

     ...Travel Offering Nursing Profession...  ...Specialty Utilization Review Job ID 38399...  ...with interdisciplinary teams to manage adult and...  ...Conduct concurrent reviews, medical necessity...  ...Unit Details: - 100% remote work environment - Rotation... 
    Remote work
    Medical
    Weekly pay
    Shift work
    Weekend work
    Day shift

    Providence SoCal Shared Services Case Management

    Torrance, CA
    5 days ago
  • $61.05k - $98.33k

     ...Itemization Review Nurse The Itemization Review Nurse provides a summary...  ...on a UBIB submitted by a medical facility to determine accuracy...  ...of billed charges. This is a remote position. Essential...  ...ability to work with Leadership Team(s) within a positive team environment... 
    Remote work
    Medical
    Full time
    Work at office
    Flexible hours

    CorVel

    United States
    5 days ago
  •  ...Review Nurse This is a contract assignment that will start right away and end on April 30th 2024 Summary Description: The review nurse is responsible for medical record abstractions and overreads during the annual Healthcare Effectiveness Data and Information... 
    Remote work
    Medical
    Contract work
    Immediate start

    HireOps Staffing LLC

    United States
    1 day ago
  • $61.05k - $98.33k

     ...Itemization Review NurseThe Itemization Review Nurse provides a summary and analysis of items...  ...on a UBIB submitted by a medical facility to determine accuracy...  ...billed charges. This is a remote position.Essential...  ...ability to work with Leadership Team(s) within a positive team... 
    Remote work
    Medical
    Full time
    Work at office
    Flexible hours

    CERIS Health

    Fort Worth, TX
    2 days ago
  •  ...Utilization Management in spine care. You will review spine-related authorization requests, evaluate documentation against medical necessity guidelines, and work with...  ...decisions. The role requires 3-5+ years of nursing experience, knowledge of UM processes, and strong... 
    Remote job
    Medical

    CVS Health Corporation

    Austin, TX
    3 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!