Physician Reviewer Job at Med Review Inc, New York, NY

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  • Med Review Inc
  • New York, NY

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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