Medical Director – Physician Reviewer

October 24

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MedReview Inc.

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Healthcare Insurance • Finance

MedReview Inc. is a leading provider of advanced payment integrity solutions, specializing in healthcare claims. They work with a wide range of clients, including health plans, government agencies, and payors, to reduce unnecessary waste and save billions of dollars. Their team of highly trained physicians, registered nurses, and certified coders conduct thorough clinical and coding reviews to identify inaccuracies in healthcare claims. MedReview employs proprietary algorithms to analyze complex data and detect suspicious payment trends, offering a unique blend of clinical expertise and advanced technology to maximize efficiencies and improve healthcare cost management.

201 - 500 employees

⚕️ Healthcare Insurance

💸 Finance

📋 Description

• Reviewing hospital medical records submitted for DRG Clinical Validation Review to ensure select diagnoses were billed appropriately and are supported in the medical record. • Producing a concise summary of the clinical course, including diagnostic studies and other relevant data. • Composing a rationale consistent with guidelines, literature, client policy, and standard of care for any adverse finding. • Reviewing cases to identify potentially preventable near-term readmission, identify appropriate inpatient Level of Care, and assist with Independent Peer Review, and Utilization Management. • Developing and updating DRG Clinical Validation Review criteria. • Participating in quality assurance activities related to clinical review programs.

🎯 Requirements

• MD/DO degree from an accredited medical school with relevant postgraduate residency or fellowship training. • Five or more years of full-time equivalent clinical practice experience is mandatory. • Utilization management, DRG review, peer review, and claim review experience is desirable. • Active, valid, and non-restricted licensure to practice medicine or a health profession in at least one state of the United States and documentation of re-licensure at the time of the renewal period. • Documentation of current Board certification by a member Board of the American Board of Medical Specialties (M.D.) or by a member Board of the American Osteopathic Association (D.O.) or in the case of a D.P.M. by the American Board of Podiatric Surgery. • Understanding of the principles of DRG clinical validation review, utilization review, evidence-based medicine and the healthcare and health insurance industry in general. • Solid quantitative and analytical skills.

🏖️ Benefits

• Healthcare that fits your needs - We offer excellent medical, dental, and vision plan options that provide coverage to employees and dependents. • 401(k) with Employer Match - Join the team and we will invest in your future • Generous Paid Time Off - Accrued PTO starting day one, plus additional days off when you’re not feeling well, to observe holidays. • Wellness - We care about your well-being. From Commuter Benefits to FSAs we’ve got you covered. • Learning & Development - Through continued education/mentorship on the job and our investment in LinkedIn Learning, we’re focused on your growth as a working professional.