Medical Consultant Reviewer - Internist PRN or Part-Time

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.

Benefits

• Medical, dental and vision insurance
• Paid time off for vacation, illness and volunteering
• Retail savings plan with employer contribution
• Adoption financial assistance
• Paid parental leave
• And much more!

Medical Consultant Reviewer - Internist

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 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.

Key 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.
• Take part in fair hearings, representing clinical determinations when required.
• Participate 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: Internist.
• 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.