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Associate Reviewer Jobs (NOW HIRING)

Peraton

Nurse Reviewer - Medicaid

Reston, VA · On-site

$66K - $106K/yr

Nurse Reviewer - Medicaid Job Locations US Requisition ID 2026-169096 Position Category Business ... Bachelors and 5 years of experience, Masters degree and 3 years of experience, Associates and 7 ...

IQVIA

Associate Director, Medical Reviewer

Durham, NC · Remote

$115K - $322K/yr

Associate Director, Medical Review (MLR) Location : Home-based in USA Job Overview: IQVIA Pharma Review provides outsourced medical copy review and approval services and advisory services to the ...

Peraton

Nurse Reviewer - Medicaid

Herndon, VA · On-site

$66K - $106K/yr

Nurse Reviewer - Medicaid Job Locations US Requisition ID 2026-169096 Position Category Business ... Bachelors and 5 years of experience, Masters degree and 3 years of experience, Associates and 7 ...

Elevance Health

Nurse Reviewer I

Los Angeles, CA · On-site

$35.54 - $55.73/hr

Nurse Reviewer I Nurse Reviewer I *Seeking RNs that have a current, unrestricted RN license in ... Virtual - This role enables associates to work virtually full-time, except for required in-person ...

Zelis

Inpatient DRG Reviewer

Perform readmission reviews, including evaluating prior and current admissions to determine ... Zelis' full-time associates are eligible for a highly competitive benefits package as well, which ...

Peraton

Nurse Reviewer - Medicaid

$66K - $106K/yr

The Medical Reviewer requires the individual to conduct medical record reviews and to apply sound ... Bachelors and 5 years of experience, Masters degree and 3 years of experience, Associates and 7 ...

Elevance Health

Nurse Reviewer I

Woodland Hills, CA · On-site

$35.54 - $55.73/hr

Nurse Reviewer I *Seeking RNs that have a current, unrestricted RN license in either the state of ... Virtual - This role enables associates to work virtually full-time, except for required in-person ...

Elevance Health

Nurse Reviewer I

Chicago, IL · On-site

$35.54 - $55.73/hr

Nurse Reviewer I Nurse Reviewer I *Seeking RNs that have a current, unrestricted RN license in ... Virtual - This role enables associates to work virtually full-time, except for required in-person ...

Zelis

Inpatient DRG Reviewer

Perform readmission reviews, including evaluating prior and current admissions to determine ... Zelis' full-time associates are eligible for a highly competitive benefits package as well, which ...

Zelis

Inpatient DRG Reviewer

Perform readmission reviews, including evaluating prior and current admissions to determine ... Zelis' full-time associates are eligible for a highly competitive benefits package as well, which ...

Zelis

Inpatient DRG Reviewer

Perform readmission reviews, including evaluating prior and current admissions to determine ... Zelis' full-time associates are eligible for a highly competitive benefits package as well, which ...

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Nurse Reviewer - Medicaid

Reston, VA • On-site

Peraton
IT Services • 10K+ employees
Learn more about Peratonexternal

$66K - $106K/yr

Other

This job post has expired today. Applications are no longer accepted.

Peraton rating

8.3

Company rating: 8.3 out of 10

Based on 56 frontline employees who took The Breakroom Quiz

Job description


Nurse Reviewer - Medicaid
Job Locations
US
Requisition ID
2026-169096
Position Category
Business Controls
Clearance
No Clearance Required
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 Medical Reviewer to our SGS team of talented professionals.

What you'll do:

The Medical Reviewer requires the individual to conduct medical record reviews and to apply sound clinical judgment to claim payment decisions.

Responsibilities may include additional 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. The incumbent will use a variety of tools to identify and develop cases for future administrative action, including referral to law enforcement, education, over payment recovery. Will work with external agencies to develop cases and corrective actions as well as respond to requests for data and support.

Roles and Responsibilities:

    Ability to present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government
  • Research regulations and cite violations.
  • Conduct self-directed research to uncover problems in Medicaid payments made to institutional and non-institutional providers.
  • Make claim payment decisions based on clinical knowledge
  • This position may require the incumbent to appear in court to testify about work findings.
  • Ability to compose correspondence, reports, and referral summary letters.
  • Ability to communicate effectively, internally and externally.
  • Ability to handle confidential material.
  • Ability to report work activity on a timely basis.
  • Ability to work independently and as a member of a team to deliver high quality work.
  • Ability to attend meetings, trainings, and conferences as needed. Overnight travel may be required.
  • Telework available from contiguous United States.

Qualifications

Basic Qualifications:

  • Bachelors and 5 years of experience, Masters degree and 3 years of experience, Associates and 7 years of experience
  • At least 3 years of experience in the medical field as a Registered Nurse or other clinician, and/or experience in review of medical claims for coverage and medical necessity.
  • Current/Active Nursing or Physical Therapy license in state of residence.
  • Strong investigative skills
  • Strong communication and organization skills
  • Strong PC knowledge and skills
  • U.S. citizenship required

Desirable Qualifications:

  • Experience in reviewing claims for technical requirements, performing medical review, and/or developing fraud cases
  • Knowledge of Medicaid requirements, laws, rules and regulations related to payment for services billed
  • Have a CPC (Certified Professional Coder) certificate.

Peraton Overview

Peraton is a next-generation national security company that drives missions of consequence spanning the globe and extending to the farthest reaches of the galaxy. As the world's leading mission capability integrator and transformative enterprise IT provider, we deliver trusted, highly differentiated solutions and technologies to protect our nation and allies. Peraton operates at the critical nexus between traditional and nontraditional threats across all domains: land, sea, space, air, and cyberspace. The company serves as a valued partner to essential government agencies and supports every branch of the U.S. armed forces. Each day, our employees do the can't be done by solving the most daunting challenges facing our customers. Visit peraton.com to learn how we're keeping people around the world safe and secure.

Target Salary Range
$66,000 - $106,000. This represents the typical salary range for this position. Salary is determined by various factors, including but not limited to, the scope and responsibilities of the position, the individual's experience, education, knowledge, skills, and competencies, as well as geographic location and business and contract considerations. Depending on the position, employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay.
EEO
EEO: Equal opportunity employer, including disability and protected veterans, or other characteristics protected by law.

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About Peraton

Sourced by ZipRecruiter

At Peraton, we re at the forefront of delivering the next big thing every day. We re the partner of choice to help solve some of the world s most daunting challenges, delivering bold, new solutions to keep people around the world safer and more secure.

Industry

It services

Company size

10,000+ Employees

Headquarters location

Herndon, VA, US

Year founded

2017

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