Medical Consultant Reviewer - Pediatrician Part-Time or On-Call
About The Position
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. 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.
Requirements
- 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
Nice To Haves
- Prior utilization management, peer review, or appeals experience (helpful but not required)
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.
Benefits
- 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
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What This Job Offers
Job Type
Part-time
Career Level
Mid Level
Education Level
Ph.D. or professional degree
