MedReview Inc. helps payors identify inaccurate medical claims to save millions in overpayments.

Medical Director – Physician Reviewer

Medical DirectorMedical DirectorFull TimeRemoteTeam 201-500H1B No SponsorCompany Site LinkedIn

Location

United States

Posted

143 days ago

Salary

$220K - $230K / year

Professional Certificate5 yrs expEnglish

Job 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.

Job 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.