DRG Clinical Validation Nurse

MedReview Inc.

Registered Nurse performing clinical validation to ensure accuracy in diagnosis codes at MedReview. Analyzing medical records and collaborating with healthcare professionals for high-quality healthcare standards.

Posted 7/30/2026full-timeRemote • 🇺🇸 United StatesJuniorMid-Level💰 $85,000 - $95,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical validation, including the interpretation of diagnosis codes and clinical guidelines, while maintaining high-quality case reviews. Proficient in ICD-10 coding and knowledgeable in health insurance terminology and regulatory guidelines.

Highest-signal resume keywords

Clinical ValidationICD-10 CodingRegistered Nurse LicensureCertified Coding SpecialistHigh-Volume Production Environment

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical ValidationICD-10 CodingDRG ValidationAnatomy and PhysiologyDiagnostic ProceduresSurgical ProceduresCase ManagementPayment IntegrityMedical Record InterpretationRationale Writing

Soft Skills

Attention to DetailQuality ManagementClear CommunicationAnalytical ThinkingTime Management

Tools & Technologies

Windows PCMultiple Applications

Certifications & Qualifications

Registered NurseCertified Coding SpecialistCertified Inpatient CoderCCDS CertificationCDIP Certification

Industry Keywords

Health InsuranceRegulatory GuidelinesClinical GuidelinesMedical RecordPayment Integrity

About the role

Key responsibilities & impact

Perform clinical validation by ensuring diagnosis codes billed by the provider are supported within the medical record
Must be able to interpret clinical guidelines/criteria and apply to clinical review
Solid understanding of anatomy and physiology, diagnostic and surgical procedures developed from specialized training and extensive experience with ICD-10-PCS code assignments
Demonstrates the ability to accurately interpret the medical record
Writes clear, accurate and concise rationales in support of findings
Maintains and manages case reviews with a high emphasis on quality
Demonstrates the ability to work in a high – volume production environment
Knowledge of health insurance business, industry terminology, and regulatory guidelines

Requirements

What you’ll need

Minimum of two years’ experience in clinical validation in a payment integrity setting required
May consider nurses with inpatient claims auditing experience or case management experience.
Unrestricted Registered Nurse with active RN licensure required
CCS (Certified Coding Specialist) or CIC (Certified Inpatient Coder) certification preferred
CCDS or CDIP Certification preferred
Knowledge of ICD-10 coding
Basic Knowledge of DRG validation and coding
Ability to use Windows PC with the ability to utilize multiple applications at the same time.

Benefits

Comp & perks

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.