Medical Consultant Reviewer - Internist PRN or Part-Time

COMAGINE HEALTH

29d•Remote

About The Position

Comagine Health is seeking a Board-Certified Internist 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.

Requirements

MD or DO required
Active, current, unrestricted MD or DO license in the District of Columbia or willing to obtain this.
Board Certification Internist.
Minimum of 7 years of clinical practice experience preferred

Nice To Haves

Prior utilization management, peer review, or appeals experience (helpful but not required)

Responsibilities

Perform clinical reviews and appeals.
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.