Physician Reviewer

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