Medical Consultant Reviewer- Pediatrician PRN D.C.

Why Comagine Health?

Comagine Health is a national, mission-driven, nonprofit organization with over 50 years of experience in health care quality consulting and quality improvement services. We assist front-line providers and engage health care partners to improve care delivery and patient outcomes. Our remote workforce plays a vital role in our success, offering opportunities to make a difference from anywhere in the U.S. and enjoying better work-life balance.

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!

Role Purpose

Comagine Health is seeking a pediatrician to serve as a Medical Consultant Reviewer on a part-time or per-diem basis. This role performs clinical reviews and appeals across multiple lines of business, including Medicaid, Workers’ Compensation, and private healthcare products, applying evidence-based medicine and sound clinical judgment. This position is fully remote in the District of Columbia.

Key Responsibilities

• Perform clinical reviews and appeals utilizing pediatrician 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.
• 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

• MD or DO required
• Pediatrician
• Clinical experience or board certification in Developmental and Behavioral Pediatrics preferred
• Minimum of 7 years of clinical practice experience preferred
• Preferred current or recent clinical practice in Developmental and Behavioral Pediatrics preferred
• Prior utilization management, peer review, or appeals experience (helpful but not required)