Physician Reviewer

Job description

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: Qualifications: - 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 o...