Physician Reviewer

<strong><span style="font-size:12pt;"><span style="line-height:115%;"><span style="font-family:Aptos, sans-serif;">Position Summary:</span></span></span></strong><br><br><span style="font-size:12pt;"><span style="line-height:115%;"><span style="font-family:Aptos, sans-serif;">We are seeking a highly experienced DRG Clinical <strong>Physician Reviewer</strong> 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.</span></span></span><br><br><span style="font-size:12pt;"><span style="line-height:115%;"><span style="font-family:Aptos, sans-serif;">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.</span></span></span><br><br><span style="font-size:12pt;"><span style="line-height:115%;"><span style="font-family:Aptos, sans-serif;"><strong>Responsibilities:</strong></span></span></span><ul style="margin-bottom:11px;"><li style="margin-left:8px;"><span style="font-size:12pt;"><span style="line-height:115%;"><span style="font-family:Aptos, sans-serif;">Perform DRG Clinical Validation reviews to ensure diagnoses are accurate, supported, and compliant </span></span></span></li><li style="margin-left:8px;"><span style="font-size:12pt;"><span style="line-height:115%;"><span style="font-family:Aptos, sans-serif;">Evaluate medical records, diagnostic findings, and treatment plans using evidence-based guidelines</span></span></span></li><li style="margin-left:8px;"><span style="font-size:12pt;"><span style="line-height:115%;"><span style="font-family:Aptos, sans-serif;">Produce clear, concise clinical summaries and determinations within established turnaround times</span></span></span></li><li style="margin-left:8px;"><span style="font-size:12pt;"><span style="line-height:115%;"><span style="font-family:Aptos, sans-serif;">Identify opportunities for improved documentation, coding accuracy, and cost containment</span></span></span></li><li style="margin-left:8px;"><span style="font-size:12pt;"><span style="line-height:115%;"><span style="font-family:Aptos, sans-serif;">Conduct readmission and level of care reviews, including outlier and appeal cases</span></span></span></li><li style="margin-left:8px;"><span style="font-size:12pt;"><span style="line-height:115%;"><span style="font-family:Aptos, sans-serif;">Collaborate with internal teams and, when needed, engage with providers to support clinical findings</span></span></span></li><li style="margin-bottom:11px;margin-left:8px;"><span style="font-size:12pt;"><span style="line-height:115%;"><span style="font-family:Aptos, sans-serif;">Contribute to quality assurance initiatives and ongoing program development</span></span></span></li></ul><strong><span style="font-size:12pt;"><span style="line-height:115%;"><span style="font-family:Aptos, sans-serif;">Qualifications:</span></span></span></strong><ul style="margin-bottom:11px;"><li style="margin-left:8px;"><span style="font-size:12pt;"><span style="line-height:115%;"><span style="font-family:Aptos, sans-serif;">MD/DO required with active, unrestricted U.S License </span></span></span></li><li style="margin-left:8px;"><span style="font-size:12pt;"><span style="line-height:115%;"><span style="font-family:Aptos, sans-serif;">Board Certification required (ABMS or AOA)</span></span></span></li><li style="margin-left:8px;"><span style="font-size:12pt;"><span style="line-height:115%;"><span style="font-family:Aptos, sans-serif;">5+ years of clinical practice experience</span></span></span></li><li style="margin-left:8px;"><span style="font-size:12pt;"><span style="line-height:115%;"><span style="font-family:Aptos, sans-serif;">REQUIRED: Strong utilization review experience (UM, DRG Validation, or clinical documentation review) </span></span></span></li><li style="margin-left:8px;"><span style="font-size:12pt;"><span style="line-height:115%;"><span style="font-family:Aptos, sans-serif;">Experience with DRG Validation, CDI, or claims review strongly preferred</span></span></span></li><li style="margin-left:8px;"><span style="font-size:12pt;"><span style="line-height:115%;"><span style="font-family:Aptos, sans-serif;">Proven ability to interpret complex clinical data and apply guidelines objectively </span></span></span></li><li style="margin-bottom:11px;margin-left:8px;"><span style="font-size:12pt;"><span style="line-height:115%;"><span style="font-family:Aptos, sans-serif;">Strong written communication skills with the ability to clearly justify clinical decisions </span></span></span></li></ul><strong><span style="font-size:12pt;"><span style="line-height:115%;"><span style="font-family:Aptos, sans-serif;">Why This Role Stands Out:</span></span></span></strong><ul style="margin-bottom:11px;"><li style="margin-left:8px;"><span style="font-size:12pt;"><span style="line-height:115%;"><span style="font-family:Aptos, sans-serif;">100% remote – work from anywhere in the U.S </span></span></span></li><li style="margin-left:8px;"><span style="font-size:12pt;"><span style="line-height:115%;"><span style="font-family:Aptos, sans-serif;">High-impact role influencing clinical accuracy and healthcare outcomes</span></span></span></li><li style="margin-left:8px;"><span style="font-size:12pt;"><span style="line-height:115%;"><span style="font-family:Aptos, sans-serif;">Join a growing, mission-driven team at the intersection of clinical care and healthcare analytics </span></span></span></li><li style="margin-bottom:11px;margin-left:8px;"><span style="font-size:12pt;"><span style="line-height:115%;"><span style="font-family:Aptos, sans-serif;">Consistent, structured workflow with meaningful case variety </span></span></span></li></ul>Compensation: 230K