Remote Medicare Medical Review Nurse - Fraud Investigator
Peraton
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-LjbffrVacancy posted 1 day ago
Similar jobs that could be interesting for youBased on the Remote Medicare Medical Review Nurse - Fraud Investigator in Reston, VA vacancy
- ...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 workMedical
Peraton
Reston, VA1 day ago - ...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 workMedical
WPS Health Solutions
Indianapolis, IN1 day ago - ...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 workMedical
WPS Health Solutions
Minneapolis, MN1 day ago - ...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 workMedical
WPS Health Solutions
Hampton, VA1 day ago - ...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 workMedical
WPS Health Solutions
Des Moines, IA1 day ago - ...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 workMedical
WPS Health Solutions
Madison, WI1 day ago - ...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 workMedical
WPS—A health solutions company
Indiana1 day ago - ...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....Remote workMedical
WPS—A health solutions company
Illinois1 day ago - ...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 workMedical
WPS Health Solutions
Detroit, MI1 day ago - ...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 workMedical
WPS Health Solutions
Columbus, OH1 day ago - ...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
- 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
- ...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
$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 community The Fraud and Waste... ...conducting comprehensive investigations of reported,... ...areas to evaluate medical necessity, appropriateness... ...stakeholders. Review claims, provider... ...Style Fully remote in South Carolina,... ...life for people with Medicare and Medicaid,...Remote workMedicalFull timeTemporary workApprenticeshipWork at officeWork from homeHome officeMonday to FridayHumana
Columbia, SC3 days ago- ...Collaborating with the Medical Director, the full-time Registered Nurse Utilization Review will manage care variance reduction,... ...appropriate resources while working remotely. Key responsibilities Assist... ...in Medical Management for Medicare and/or Medicaid populations Utilization...Remote workMedicalFull time
Virtual Vocations Inc
United States2 days ago $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 hoursMJHS
New York, NY2 days ago$52 - $56 per hour
...for a New York health plan (Medicare Advantage, Medicaid and... ...and you'll apply the same medical necessity judgment you built... ...management. 100% remote (U.S.) | Contract | $52–$5... ...appeals end to end: intake, investigation, clinical review, decision and notification...Remote jobMedicalContract workAfternoon shiftPhaxis LLC
New York, NY13 days ago- ...Job Title Registered Nurse (RN) for Critical... ...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
The CKHobbie Group
United States4 days ago $66k - $68k
...WPS is seeking an Appeals Nurse (RN) to evaluate medical records and claims for first-level Medicare appeals, ensuring medical necessity and compliance with guidelines.... ...redeterminations promptly. The role supports remote work in approved US states, offers a salary of...Remote workMedicalWPS—A health solutions company
Missouri1 day ago- ...Nurse Auditor Have you ever looked a medical bill and immediately noticed something was wrong? Were you itching to use your expertise to fix it? We've... ...containment. Join our team and maximize client savings by reviewing medical bills from a nurse perspective, including...Remote workMedicalImmediate start
Rising Medical Solutions
United States5 days ago - ...perform pre-service and post-service utilization reviews and appeals for DMEPOS. You will collaborate with our Medical Director on benefit and medical necessity... ...meeting criteria, and referring non-meeting cases. Remote opportunities available; competitive compensation...Remote workMedical
Integra Partners
Springfield, IL1 day ago - ...solutions company, is hiring an Appeals Nurse to review medical records and claims for first-level... ...ensuring medical necessity and adherence to Medicare guidelines. The role collaborates with... ...compliance with CMS requirements. Remote work is available from select states...Remote workMedical
WPS—A health solutions company
Minnesota1 day ago - ...HealthHelp, a WNS company, seeks a Clinical Review Nurse for a fully remote role in the United States. You will perform prospective reviews for medical necessity on prior authorization requests across multiple specialty programs and refer non-qualifying cases to Physician...Remote workMedical
HealthHelp - A WNS Company
Houston, TX1 day ago - ...conduct pre-service and post-service utilization reviews and appeals within a NCQA-compliant UM program, collaborating with our Medical Director. The role emphasizes applying... ...approvals, referrals, and handling appeals. Remote opportunities available and strong team...Remote workMedical
Integra Partners
Ohio1 day ago - 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
- ...perform pre-service and post-service utilization reviews and appeals in a managed care UM program. This role collaborates with the Medical Director on benefit and medical necessity... ..., aligned with NCQA standards. The UM Nurse will review requests, approve those meeting...Remote workMedical
Integra Partners
Clifton, TX1 day ago - ...WPS, a health solutions company, is seeking an Appeals Nurse (RN) to review medical records and Medicare denial cases for medical necessity. The role... ...clinical experience and strong communication skills. Remote work options available for approved states, including...Remote workMedical
WPS—A health solutions company
Texas1 day ago - ...WPS Health Solutions is seeking an Appeals Nurse (RN) to review medical records and claims for first-level Medicare appeal cases, assessing medical necessity and adherence to CMS guidelines. The role collaborates with Appeals Examiners to ensure timely redeterminations...Remote workMedical
WPS Health Solutions
Green Bay, WI1 day ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Medicare Medical Review Nurse - Fraud Investigator. Be the first to apply!
Related searches
- remote director Reston, VA
- automation engineer remote Reston, VA
- it manager remote Reston, VA
- global remote customer service jobs Reston, VA
- remote design intern Reston, VA
- remote legal internship Reston, VA
- remote operations manager Reston, VA
- remote consultant Reston, VA
- software testing remote Reston, VA
- remote medical claims processor Reston, VA