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: 230KOriginally posted on Himalayas
Who can apply
Eligible countries: United States. Accepted UTC offsets: UTC-10, UTC-9, UTC-8, UTC-7, UTC-6, UTC-5, UTC+14. Review the full description for employer-specific work authorization, residency and schedule requirements.