California Licensed DRG Clinical Manager

Job Summary

A company is looking for a DRG Clinical Validation Manager responsible for managing clinical validation solutions and leading a team in healthcare payment methodologies.

Key Responsibilities

• Collaborate with a multi-disciplinary team to implement DRG clinical validation processes
• Lead and develop the DRG Clinical Validation team while ensuring accountability and clinical excellence
• Oversee clinical claims review processes and maintain quality assurance standards

Required Qualifications

• Bachelor's degree in health administration, business, or nursing
• 5+ years of experience in healthcare billing and coding
• 3+ years of experience in claims auditing and recovery auditing
• Nursing or MD/DO license required, along with certifications such as CCS, CCDS, or CDIP
• 3+ years of supervisory experience in a relevant field