In this role, you will review complex hospital cases to ensure accurate DRG assignment, validate ... Evaluate medical records, diagnostic findings, and treatment plans using evidence-based guidelines
Med Review
4 jobs near Columbus, OH
In this role, you will review complex hospital cases to ensure accurate DRG assignment, validate ... Evaluate medical records, diagnostic findings, and treatment plans using evidence-based guidelines
Physician Reviewer
Manhattan, NY ยท On-site
In this role, you will review complex hospital cases to ensure accurate DRG assignment, validate ... Evaluate medical records, diagnostic findings, and treatment plans using evidence-based guidelines
Physician Reviewer
Manhattan, NY ยท On-site
In this role, you will review complex hospital cases to ensure accurate DRG assignment, validate ... Evaluate medical records, diagnostic findings, and treatment plans using evidence-based guidelines
Medical Records Specialist
Manhattan, NY ยท On-site
$47K/yr
To review correspondence received and identify the type of document being submitted for action * To ... To contact Operation Unit Manager for further medical records processing * To assist reviewer in ...
Medical Records Specialist
Manhattan, NY ยท On-site
$47K/yr
To review correspondence received and identify the type of document being submitted for action * To ... To contact Operation Unit Manager for further medical records processing * To assist reviewer in ...
Customer Service Representative
Manhattan, NY ยท On-site
$24.10/hr
Review customer and client accounts and provide updates regarding claim audits, review statuses, and related inquiries. * Conduct outbound calls to providers to request medical records and supporting ...
Customer Service Representative
Manhattan, NY ยท On-site
$24.10/hr
Review customer and client accounts and provide updates regarding claim audits, review statuses, and related inquiries. * Conduct outbound calls to providers to request medical records and supporting ...
Other
Re-posted 9 days ago
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:
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
- 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
- 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