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