Medical Director/ Physician Reviewer (Healthcare)

TL;DR

Medical Director/ Physician Reviewer (Healthcare): Reviewing hospital medical records for DRG Clinical Validation to ensure appropriate billing and documentation with an accent on clinical course summaries and rationale composition. Focus on identifying preventable readmissions, determining appropriate inpatient levels of care, and performing independent peer reviews.

Location: Must be located within a US state territory

Salary: $220,000–$230,000 per year

Company

hirify.global provides specialized clinical validation and medical record review services for the healthcare industry.

What you will do

• Conduct DRG Clinical Validation Reviews of hospital medical records to verify billed diagnoses.
• Produce concise clinical course summaries and evidence-based rationales for adverse findings.
• Perform readmission and cost outlier level of care reviews.
• Execute Independent Peer Review (IRO) and Utilization Management (UM) activities.
• Develop and update DRG Clinical Validation Review criteria and model language.
• Participate in quality assurance and the onboarding/training of new Medical Directors.

Requirements

• MD/DO degree from an accredited medical school with postgraduate residency or fellowship training.
• Active, valid, and non-restricted licensure to practice medicine in at least one US state.
• Current Board certification by ABMS, AOA, or American Board of Podiatric Surgery.
• Minimum 5 years of full-time clinical practice experience.
• Must be located within a US state territory at the time of performing reviews.
• Strong quantitative, analytical, and written communication skills.

Nice to have

• Additional education in health policy or management.
• Experience in utilization management, DRG review, peer review, or claim review.

Culture & Benefits

• Comprehensive medical, dental, and vision insurance for employees and dependents.
• 401(k) plan with employer matching.
• Generous paid time off (PTO) and sick leave.
• Wellness perks including Commuter Benefits and FSAs.
• Professional growth through LinkedIn Learning and on-the-job mentorship.