A company is looking for a Medical Director, DRG Audit & AI Innovation.
Key Responsibilities
Conduct DRG clinical reviews to validate diagnoses, procedures, and coding
Provide structured feedback to enhance AI adjudication and inform policy development
Serve as a subject matter expert and participate in quality improvement initiatives
Required Qualifications
MD / DO with an active, unrestricted medical license
Board certification in Internal Medicine, Surgery, Family Medicine, or related specialty
3+ years of experience in DRG audits, utilization management, or clinical validation reviews
Familiarity with ICD-10-CM / PCS, AHA Coding Clinic guidance, and CMS DRG policies
Experience with AI-powered or technology-enabled audit platforms is preferred
Medical Director • Rochester, New York, United States