Medical Review Team Lead - Medicaid

Responsibilities SafeGuard Services (SGS), a subsidiary of Peraton , performs data analysis, investigation, and medical review to detect, prevent, 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 professionals. What you'll do: As a Nurse Reviewer Team Lead, this individual’s primary responsibilities include achieving quality objectives, workload oversight to promote timely development and resolution of medical reviews and work with the investigations team in development of cases for referral to law enforcement or other entities and provide mentoring and guidance to the medical review team. The individual exercises significant independent judgment within broadly defined policies and practices to determine the best method for accomplishing work and achieving objectives. The individual must be well versed in research on medical claims data and other sources of information to identify problems, review sophisticated data model output, and utilize a variety of tools to detect situations of potential fraud and to support the ongoing fraud investigations and requests for information. Act as a…