Physician Reviewer

Job not on LinkedIn

🕒 June 25

🇺🇸 United States – Remote

💵 $230k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 35%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.Why this score:

• Open for 138 days.
• Jobs at this company usually fill in 47 days.
• Reposted once.

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MedReview Inc.

WebsiteLinkedInAll Job Openings

201 - 500 employees

🏥 Healthcare

⚕️ Healthcare Insurance

💸 Finance

Healthcare • 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.

📋 Description

• 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

🎯 Requirements

• MD/DO required • Active, unrestricted U.S. medical license required • Board Certification required (ABMS or AOA) • 5+ years of clinical practice experience required • Strong utilization review experience (UM, DRG Validation, or clinical documentation review) required • Experience with DRG Validation, CDI, or claims review strongly preferred • Ability to interpret complex clinical data and apply guidelines objectively • Strong written communication skills with the ability to clearly justify clinical decisions

🏖️ Benefits

• 100% remote work from anywhere in the U.S. • High-impact role influencing clinical accuracy and healthcare outcomes • Growing, mission-driven team at the intersection of clinical care and healthcare analytics • Consistent, structured workflow with meaningful case variety

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