- Medical, dental and vision insurance
- Paid time off for vacation, illness and volunteering
- Retirement savings plan with employer contribution
- Adoption financial assistance
- Paid parental leave
- And much more
- Perform clinical reviews and appeals utilizing Pediatrician or Family Practice expertise.
- Apply clinical judgment and evidence-based guidelines to render timely, defensible medical necessity determinations.
- Participate in physician-to-physician discussions, including those related to potential denials.
- Provide clinical subject matter expertise to utilization management staff, case managers, and consultants.
- Participate in fair hearings, representing clinical determinations when required.
- Take part in Inter-Rater Reliability (IRR) audits to ensure consistency and quality.
- Ensure reviews meet standards for clear documentation, regulatory compliance, and sound decision-making.
- MD or DO required
- Active, current, unrestricted MD or DO license in the District of Columbia or willing to obtain this.
- Board Certification Pediatrician or Family Practice.
- Minimum of 7 years of clinical practice experience preferred
- Prior utilization management, peer review, or appeals experience (helpful but not required)
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Medical Consultant Reviewer - Washington D.C. - Comagine Health
Description
Why Comagine Health?Comagine Health is a national, mission-driven, nonprofit organization that has engaged in health care quality consulting and quality improvement services for more than 50 years.
We are leaders in assisting front-line providers and engaging health care partners to improve care delivery and patient outcomes.
Our talented remote workforce spans the country and plays a vital role in our success. We go beyond merely providing a remote work option; we support and embrace it. We offer opportunities to make a difference from anywhere in the U.S. and enjoy better work-life balance. An annual stipend gives you the freedom to enhance your workspace with options that suit your needs.
We believe in an environment that allows you to thrive both personally and professionally. For .50 FTE or full-time employees we offer benefits that include:
Remote
Schedule: Part-Time or Per Diem | Flexible | Non-Patient-Facing: 8-19 hours per week.
Role Purpose
Comagine Health is seeking a Board-Certified Pediatrician to work as a Medical Reviewer.
This position is fully remote within the D.C. area. Obtaining a licensure from D.C. is mandatory.
This position is well suited for physicians looking for flexible, non-clinical work while maintaining an active or reduced clinical practice.
Key Responsibilities
Education
Comagine Health is an equal opportunity employer and is committed to creating a diverse, equitable, and inclusive workplace.
Physical Requirements & Work Environment
This position is primarily remote and performed in a home-based setting, requiring reliable internet access and a workspace free from significant distractions. The role involves frequent use of computers, phones, and virtual communication tools. Employees must be able to sit for extended periods, communicate effectively.
Some positions may require operating a motor vehicle for business purposes; in such cases, employees must maintain a valid driver's license and meet the organization's driving eligibility requirements. Occasional travel may be required for meetings, training, or other work-related events.
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Medical Consultant Reviewer
Part time Only for registered members Washington
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Medical Consultant Reviewer
Part time Only for registered members Washington, DC
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Medical Consultant Reviewer
Part time Only for registered members Washington
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Medical Consultant Reviewer
Part time Only for registered members District of Columbia
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Senior Consultant – Material Review
Only for registered members Washington
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Senior Consultant – Material Review
Only for registered members Washington, DC
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Senior Consultant, Acuity Review Manager
Only for registered members Washington
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Senior Consultant, Acuity Review Manager
Only for registered members Washington, DC
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Fiscal Reviewer Consultant
Only for registered members Bethesda
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Healthcare Review/Audit Senior Consultant
Full time Only for registered members Tysons
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Director, Acuity Review Manager
Only for registered members Washington
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CQV Validation Engineer
Only for registered members Washington
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PEC Consultant
Only for registered members Washington
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Informatica/AWS Developer
Only for registered members Washington
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Permit Technician – Public Space
Only for registered members Washington
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Sr Technical Consultant – Delinea IAM/PAM
Only for registered members Washington
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Consulting Project Manager-CTJ-TS
Full time Only for registered members Washington
-
Assistant Project Manager
Only for registered members Washington
-
Senior Revenue and Accounts Receivable Accountant
Only for registered members Washington
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Classification Analyst
Only for registered members Washington
-
Managing Economist
Only for registered members Washington