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Physician Reviewer

MedReview

Role overview

Qualifications

  • 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)

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

Key facts

  • Remote from: United States
  • Full time
  • Senior (5-10 years)
  • English

Hard skills

Utilization Management Clinical Documentation Evidence-Based Practice Online Communication Program Development

Other skills

  • Quality Assurance
  • Collaboration
  • Detail Oriented

About the company

MedReview logo

MedReview

Hospitals & Health Care

MedReview is One of the Leading Medical Claims Auditors in the Country . Our Medical Claims Audits, Pharmacy Audits and Dependent Eligibility Audits Help Self Insured Plan Sponsors Reduce Their Healthcare Costs. Organizations that self insure their health plans are experiencing double digit cost increases. Health plan costs are now one of their largest operating expenses. MedReview's medical claims audits and our dependent eligibility audit programs will help you control your self insured plan's expenses and will result in a positive contribution to your organization's bottom line. MedReview's medical claims audits will also help you comply with ERISA, Sarbanes-Oxley and other regulatory requirements that mandate you act in the best interests of your plan's participants.

Company details

IndustryHospitals & Health Care
Company size51 - 200

Links

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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:
  • 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

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MR

Marcus Rivera

Chief Revenue Officer

m.rivera@company.com
linkedin.com/in/marcusrivera
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