Physician Reviewer

TL;DR

Physician Reviewer (DRG Validation): Review complex hospital cases to ensure accurate DRG assignment, validate clinical documentation, and support evidence-based determinations with an accent on healthcare quality and reimbursement integrity. Focus on evaluating medical records, diagnostic findings, treatment plans, and conducting readmission and level of care reviews.

Location: 100% remote – work from anywhere in the U.S. MD/DO with active, unrestricted U.S. License required

Compensation: 230K

Company

Growing, mission-driven team at the intersection of clinical care and healthcare analytics.

What you will do

• 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 providers to support clinical findings and contribute to quality assurance

Requirements

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

Culture & Benefits

• 100% remote work from anywhere in the U.S.
• High-impact role influencing clinical accuracy and healthcare outcomes
• Consistent, structured workflow with meaningful case variety