Position Summary The Clinical Review Medical Director is primarily responsible for reviewing hospital medical records submitted for DRG Clinical Validation Review to ensure select diagnoses were billed appropriately and are supported in the medical record.

The Medical Director will produce a concise summary of the clinical course, including diagnostic studies and other relevant data, and compose a rationale consistent with guidelines, literature, client policy, and standard of care for any adverse finding.

The Medical Director, from time to time, will also review cases to identify potentially preventable near-term readmission, identify appropriate inpatient Level of Care, and assist with Independent Peer Review, and Utilization Management.

Specific Duties:

• This list does not represent all responsibilities for this position.

Review Activities:

•   DRG Clinical Validation Readmission Review Cost...