Nurse Manager - Medicare

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 Medicare Nurse Manager to our SGS team of talented professionals

What you'll do:

This position entails providing direction to a staff of nurses and therapists that review medical records and claim data to identify and research issues of potential fraud, waste and abuse. Primary responsibilities include oversight and assistance to the development of cases for referral to law enforcement or other entities and responding to requests for data and support for existing casework.

Establish goals, objectives and plans for the unit
• Motivate staff and evaluate performance
• Plan resources to address workload needs, set priorities and report unit activity
• Develop, administer, and control a budget
• Administer compensation and other corporate polices
• Recruit and develop staff
• Telework available from contiguous United States.

Basic Qualifications:

• 10 years of experience, may have supervisory or lead experience
• Active Registered Nurse license in state of residence.
• Six years of professional experience
• Minimum of three years supervisory experience in the general area of medical/ utilization review.
• Demonstrated experience and knowledge with health care coding.
• Must have proven leadership skills and in-depth knowledge of the Medicare Program as it pertains to reviewing claims and provider behavior for indications of potential fraud, waste and abuse.
• Must have knowledge of Medicare requirements, laws, rules and regulations related to payment for services billed to the Program.
• This position requires proven leadership skills and in-depth knowledge of the Medicare Program as it pertains to reviewing claims and provider behavior for indications of potential fraud, waste and abuse.
• Excellent organizational and communications skills as well as strong PC skills.
• Ability to effectively work independently and as a member of a team.
• U.S. citizenship required.

Preferred Qualifications:

• Bachelors degree in Nursing & 10-12 years relevant experience

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.