Medical Review Team Lead (Remote, Worldwide)

Are you a seasoned nurse reviewer with a knack for leadership and a passion for upholding the integrity of healthcare? Imagine applying your clinical expertise and investigative skills to uncover fraud, waste, and abuse, all while guiding a talented team from anywhere in the world. Peraton, through its SafeGuard Services subsidiary, invites you to join our vital mission as a Medical Review Team Lead, making a tangible difference in protecting valuable resources and ensuring fair practices across the healthcare system.

Overview

Peraton is a national security company, and our SafeGuard Services (SGS) subsidiary plays a critical role in safeguarding government programs. Our dedicated team performs deep data analysis, rigorous investigations, and thorough medical reviews. We work relentlessly to detect, prevent, deter, and reduce fraud, waste, and abuse, often making referrals to recover funds. As our Medical Review Team Lead, you will become an essential part of this effort, contributing significantly to our crucial mission in a fully remote capacity.

Key Responsibilities

Ensure the highest quality standards are met for all medical reviews.
Manage workload effectively, ensuring timely completion and resolution of medical reviews.
Collaborate closely with our investigations team, developing strong cases for referral to law enforcement or other relevant entities.
Provide invaluable mentorship, guidance, and support to the medical review team members.
Exercise significant independent judgment, applying broadly defined policies to achieve objectives.
Conduct thorough research using medical claims data and other information sources to pinpoint problems.
Review sophisticated data model outputs to identify patterns of potential fraud.
Utilize various specialized tools to detect fraudulent situations and support ongoing investigations and information requests.

Requirements

Possession of an active Registered Nurse (RN) license.
Demonstrated experience in medical review or claims analysis, preferably within a fraud, waste, and abuse environment.
Proven leadership abilities with experience guiding and mentoring professional teams.
Exceptional analytical skills, with a keen eye for detail and pattern recognition.
Proficiency in researching complex medical claims data and other healthcare information.
Ability to interpret sophisticated data model outputs.
Strong independent judgment and decision-making capabilities.
Excellent communication skills, both written and verbal, for team guidance and collaborative efforts.
Must be able to work effectively in a fully remote, distributed team environment.

What You'll Gain

The opportunity to make a substantial impact on public health program integrity.
A collaborative and supportive team environment focused on a critical mission.
Significant professional growth and leadership development.
The flexibility and convenience of a fully remote, worldwide work opportunity.
Working with cutting-edge tools and sophisticated data analysis techniques.
Being part of a respected organization dedicated to national security and public service.