Physician Reviewer

medreview; United States; Remote; USD 230.000 - 240.000; Vollzeit

Benefits dieser Stelle

100% remote

Impactful clinical work

Zusammenfassung

medreview is seeking a highly experienced DRG Clinical Physician Reviewer for a fully remote, U.S.-based role. The ideal candidate will review complex hospital cases to ensure accurate DRG assignments and validate clinical documentation in a fast-paced, data-driven environment.

Requirements include an active U.S. MD/DO license, ABMS or AOA board certification, and 5+ years of clinical practice with strong utilization review experience (UM, DRG Validation, CDI).

Qualifikationen

• MD/DO with active, unrestricted U.S. medical license.
• Board Certification (ABMS or AOA).
• 5+ years of clinical practice experience.
• Strong utilization review experience (UM, DRG Validation, or clinical documentation review).

Aufgaben

• Perform DRG Clinical Validation reviews to ensure diagnoses are accurate, supported, and compliant.
• Evaluate medical records, diagnostic findings, and treatment plans using evidence-based guidelines.
• Produce clear, concise clinical summaries and determinations within established turnaround times.
• Identify opportunities for improved documentation, coding accuracy, and cost containment.
• Conduct readmission and level of care reviews, including outlier and appeal cases.
• Collaborate with internal teams and, when needed, engage with providers to support clinical findings.
• Contribute to quality assurance initiatives and ongoing program development.

Kenntnisse

Utilization review experience

DRG Validation

Clinical documentation review

Medical record review

Strong written communication

Ausbildung

MD/DO

Jobbeschreibung

Position Summary:

We are seeking a highly experienced DRG Clinical Physician Reviewer to join our growing clinical review team. This is a fully remote opportunity for a physician with a strong background in utilization review and clinical validation who thrives in a fast-paced, data-driven environment.

In this role, you will review complex hospital cases to ensure accurate DRG assignment, validate clinical documentation, and support evidence-based determinations that directly impact healthcare quality and reimbursement integrity.

Responsibilities:

• Perform DRG Clinical Validation reviews to ensure diagnoses are accurate, supported, and compliant
• Evaluate medical records, diagnostic findings, and treatment plans using evidence-based guidelines
• Produce clear, concise clinical summaries and determinations within established turnaround times
• Identify opportunities for improved documentation, coding accuracy, and cost containment
• Conduct readmission and level of care reviews, including outlier and appeal cases
• Collaborate with internal teams and, when needed, engage with providers to support clinical findings
• Contribute to quality assurance initiatives and ongoing program development

Qualifications:

• MD/DO required with active, unrestricted U.S License
• Board Certification required (ABMS or AOA)
• 5+ years of clinical practice experience
• REQUIRED: Strong utilization review experience (UM, DRG Validation, or clinical documentation review)
• Experience with DRG Validation, CDI, or claims review strongly preferred
• Proven ability to interpret complex clinical data and apply guidelines objectively
• Strong written communication skills with the ability to clearly justify clinical decisions

Why This Role Stands Out:

• 100% remote – work from anywhere in the U.S
• High-impact role influencing clinical accuracy and healthcare outcomes
• Join a growing, mission-driven team at the intersection of clinical care and healthcare analytics
• Consistent, structured workflow with meaningful case variety

Compensation: 230K