Medical Consultant Reviewer - Washington D.C. - Comagine Health

    Comagine Health
    Comagine Health Washington D.C.

    4 days ago

    Part time
    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:
    • 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
    Medical Consultant Reviewer
    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
    • 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.
    Qualifications
    Education
    • MD or DO required
    Licensure & Certification
    • Active, current, unrestricted MD or DO license in the District of Columbia or willing to obtain this.
    • Board Certification Pediatrician or Family Practice.
    Experience
    • Minimum of 7 years of clinical practice experience preferred
    Preferred
    • Prior utilization management, peer review, or appeals experience (helpful but not required)
    Equal Opportunity Employer
    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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