Medical Director – Physician Reviewer
MedReview Inc.
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteSalary
💰 $220,000 - $230,000 per year
Job Level
Lead
About the role
- 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.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
clinical validation reviewutilization managementpeer reviewclaim reviewquantitative skillsanalytical skillsevidence-based medicine
Certifications
MDDOBoard certification