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- ...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 workMedicalFraudContract workTemporary workWork at officeFlexible hours
$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 workMedicalFraudFull timeTemporary workPart timeImmediate startWork from homeWorldwideFlexible hours$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$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 workMedicalFraudContract workShift workNight shift- ...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 workMedicalFraud
- ...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
$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 workMedicalFraudHourly payMinimum wageFull timeContract workWork experience placementLive inLocal areaMonday to FridayShift work- ...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 workMedicalFraudContract workFor contractorsLocal area
- ...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
- ...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 workMedicalFraudFull timeTemporary workWork at officeWork from home
$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 workMedicalFraudFull timeTemporary workPart timeImmediate startWorldwideFlexible hours$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 workMedicalFraudFull timeLocal area- ...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
- ...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 workMedical
- ...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 workMedical
- ...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 workMedicalFlexible hours
$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- ...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....MedicalFraudWork at officeLong distanceNight shift
$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 workMedicalContract workImmediate startMonday to Friday- ...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 workMedicalImmediate start
$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 workMedicalFraudFull timePart timeImmediate startWorldwideMonday to FridayFlexible hoursWeekend workAfternoon shift- ...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 workMedicalFull timeFlexible hours
$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 workMedicalFraudFull timePart timeImmediate startWorldwideMonday to FridayFlexible hoursWeekend workAfternoon shift$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 workMedicalHourly payFull time- 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 HealthRemote workMedicalFraudFlexible hours
$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 workMedicalWeekly payShift workWeekend workDay shift$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 workMedicalFull timeWork at officeFlexible hours- ...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 workMedicalContract workImmediate start
$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 workMedicalFull timeWork at officeFlexible hours- ...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 jobMedical
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