Remote Medicare Medical Review Nurse - Fraud Investigator
Peraton
- Remote job
Peraton, a leader in national security solutions, seeks a Medical Review Nurse for Medicare fraud detection and medical claim evaluation. You will analyze medical records, apply clinical judgment, and identify regulatory violations, with the opportunity to support investigations remotely from anywhere in the United States. The role requires a nursing license, 5 years’ experience in the medical field or claim review, strong investigative abilities, and excellent communication. #J-18808-Ljbffr Peraton
- Peraton is seeking a Nurse Reviewer to join SafeGuard Services (SGS) and conduct medical record reviews, applying clinical judgment to claim payments. The role supports fraud investigations and referrals, with opportunities to develop cases for law enforcement and recovery...Remote jobMedical
- ...health‑care data analyst to perform medical record reviews and apply clinical judgment to... ...data, identify patterns of fraud, and develop cases for potential... ...agencies. The role requires nursing or clinician experience, strong investigative abilities, and U.S. citizenship...Remote jobMedical
- WPS Health Solutions seeks an Appeals Nurse (RN) to review medical records for first-level appeal cases... ...and determine medical necessity under Medicare guidelines. The role collaborates... ...clinical experience are required, with remote work options available in designated...Remote jobMedical
- Peraton is seeking a Medical Review Nurse- Medicare to perform medical record reviews and apply clinical... ...decisions. The role supports fraud detection and may involve research on... ...nursing license is required, with strong investigative, communication, and organizational skills...Remote jobMedical
- ...Health Solutions is seeking an Appeals Nurse to review medical records and claims for first-level... ...to determine medical necessity under Medicare guidelines. The role collaborates with... ...clinical experience are required, with remote work options available in approved states...Remote jobMedical
- WPS Health Solutions is seeking an Appeals Nurse to review medical records and claims for first-level appeal determinations under Medicare guidelines. The RN collaborates with... ...license, with 1+ year clinical experience. Remote work is allowed in several states with requirements...Remote jobMedical
- ...Health Solutions is seeking an Appeals Nurse (RN) to review medical records for first-level appeal cases... ...determine medical necessity under Medicare guidelines. You will collaborate with... ...communication and regulatory knowledge. Remote work is available in approved states,...Remote jobMedical
- Peraton seeks a Nurse Reviewer to join SafeGuard Services. The role involves conducting medical record reviews, applying clinical judgment to claim payments, and supporting fraud investigations with diverse data sources. The position emphasizes regulatory research, accurate...Remote jobMedical
- WPS—A health solutions company is seeking an Appeals Nurse to review medical records and claims for first-level appeal cases to determine medical necessity and adherence to Medicare coverage guidelines. The role collaborates with Appeals Examiners to ensure timely redeterminations...Remote jobMedical
- ...Health Solutions is seeking an Appeals Nurse (RN) to review medical records and claims for first-level... ...cases, determining medical necessity and Medicare coverage compliance. The RN... ...timely manner. This position supports remote work in approved states, including Ohio...Remote jobMedical
- ...Health Solutions is seeking an Appeals Nurse to review medical records for first-level appeals to determine medical necessity under Medicare guidelines. The RN collaborates with Appeals... ...year clinical experience are required. Remote work options are available in specified...Remote jobMedical
- WPS is seeking an Appeals Nurse (RN) to review medical records and denial information for first-level Medicare appeals, ensuring services meet medical necessity and CMS guidelines... ...1+ year of clinical experience, and offers remote work options in approved states, including...Remote jobMedical
- WPS—A health solutions company is seeking an Appeals Nurse (RN) to review medical records and claims for first-level appeal cases to determine medical necessity under Medicare guidelines. The role collaborates with Appeals Examiners to ensure timely redeterminations. In...Remote jobMedical
- Peraton is seeking a Nurse Reviewer to join the SafeGuard Services... .... The role involves medical record reviews,... ...claims data to uncover fraud, waste, and abuse. Telework... ...candidate will review Medicare payments, develop cases for investigations, and collaborate with external...Remote jobMedical
- WPS Health Solutions is hiring an Appeals Nurse RN to review medical records and claims for first-level appeal cases to determine medical necessity according to Medicare guidelines. This remote-friendly role supports timely redeterminations and collaborates with Appeals...Remote jobMedical
- Peraton seeks a Nurse Reviewer for SafeGuard Services to conduct medical record reviews and make informed payment decisions. You will support fraud investigations, identify issues, and refer cases for administrative action. Remote work is available from anywhere in the...Remote workMedical
- WPS Health Solutions in Columbus, OH, is seeking an Appeals Nurse to review medical records and Medicare claims for first-level appeals to determine medical necessity and coverage alignment. The role collaborates with Appeals Examiners to prepare timely redeterminations...Remote jobMedical
- ...States is seeking a clinically focused claims reviewer with an active California RN license to evaluate complex medical claims and post-service appeals. You will interpret... ...to ensure accurate determinations. This remote role offers a base hourly wage, annual bonus program...Remote jobMedicalHourly pay
- ePATHUSA, Inc. is seeking a Registered Nurse for a fully remote, Medicare-focused medical record review role. You will evaluate Part A and B claims, ensure coding accuracy, and determine compliance with national and local coverage determinations. The position supports...Remote jobMedicalLocal area
- ...States is seeking a qualified Clinical Reviewer to provide expert review of medical claims and post-service appeals... .... You will audit complex Medicare claims, apply CMS guidelines, and... ...supporting SCAN’s mission and goals. This remote role offers a comprehensive benefits...Remote jobMedical
$80.31k - $116.19k
...Our work spans Medicare Advantage, fully integrated... ...care for the most medically and socially... ...Provide clinical review of medical claims... ...Facilitate appropriate investigation of issues and... ...Quality of Care (QOC) Nurse, Medical... ...55.86 per hour Remote position An annual...Remote workMedicalHourly payFull timeFor contractorsLocal area- Seeking Registered Nurse for fully remote role to perform complex medical record and claim reviews for various services and equipment (Medicare Part A and Part B) to... ...potential indicators of fraud, waste, and abuse.... ...PI) reviews, assess investigative allegations and...Remote workMedicalContract workWork at officeLocal area
$65k - $88.6k
...caring communityThe Fraud and Waste... ...conducting comprehensive investigations of reported, alleged... ...areas to evaluate medical necessity,... ...stakeholders. Review claims, provider billing... ...Work Style Fully remote in South Carolina... ...life for people with Medicare and Medicaid,...Remote workMedicalFull timeTemporary workApprenticeshipWork at officeWork from homeHome officeMonday to Friday- ...detail-oriented Registered Nurse (RN) to join a... ...will be responsible for reviewing and evaluating critical... ...with each participant's medical and functional needs.... ...properly reported, investigated, and addressed in accordance... ...technology to support remote and hybrid work...Remote workMedicalWork from home
$77.1k - $92.52k
...Full-Time Office: Remote Salary: $... ...and HomeFirst, our Medicare and Medicaid managed... ...Affordable and comprehensive medical, dental and vision... ...: The SIU Fraud Investigator is responsible for... ...required. Knowledge of reviewing medical records/...Remote workMedicalFull timePart timeWork at officeFlexible hours- ...Review NurseThis is a contract assignment that will start right away and end on April 30th 2024Summary Description:The review nurse is responsible for medical record abstractions and overreads during the annual Healthcare Effectiveness Data and Information Set (HEDIS)...Remote workMedicalContract workImmediate start
- Peraton is seeking a Fraud Investigator to join SafeGuard Services (SGS), focusing on data analysis, investigation, and medical review to detect, prevent, deter, reduce, and refer fraud, waste, and abuse within Medicare/Medicaid programs. The role involves high-level investigations...Remote jobMedical
$61.05k - $98.33k
...Itemization Review NurseThe Itemization Review Nurse provides a summary and analysis of items by reviewing all charges on a UBIB submitted by a medical facility to determine accuracy of billed charges. This is a remote position.Essential Functions & Responsibilities:Collects...Remote workMedicalFull timeWork at officeFlexible hours$34 - $47 per hour
...UM Review NurseAstrana Health is looking for a CA-licensed Utilization Review Nurse to assist our Health Services Department. In this position... ...approve or deny outpatient medical services for patients based... ...various Health Plans. This is a remote position for CA-licensed...Remote workMedicalHourly payLive inWork at officeMonday to FridayShift work- ...Services Corporation is seeking a Nursing professional for a 6-month remote role focused on concurrent reviews and utilization management.... ...levels, and collaborate with Medical Affairs to support quality of... ...should be familiar with Medicare/Medicaid regulations and be prepared...Remote jobMedical
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