Medical Consultant Reviewer — Washington, DC at

Why Comagine Health?

Comagine Health is a national, mission-driven nonprofit organization with over 50 years of experience in healthcare quality consulting and improvement services. We are leaders in assisting front-line providers and engaging healthcare 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.

About the Role

We are 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 within the District of Columbia and is well suited for physicians looking for flexible, non-clinical work while maintaining an active or reduced clinical practice. The schedule is flexible, ranging from 8 to 19 hours per week, and is non-patient-facing.

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 and communicate effectively.

Reasonable accommodations will be provided to enable individuals with disabilities to perform essential functions.

Equal Opportunity

Comagine Health is an equal opportunity employer and is committed to creating a diverse, equitable, and inclusive workplace.

Work location

Work model: Remote

1628, 5th Street Northwest, Logan Circle/Shaw, Ward 2, Washington, District of Columbia, 20001, United States

Washington, District of Columbia

Key Responsibilities

check_circlePerform clinical reviews and appeals utilizing pediatrician expertise
check_circleApply clinical judgment and evidence-based guidelines to render medical necessity determinations
check_circleProvide clinical subject matter expertise to utilization management staff and case managers
check_circleRepresent clinical determinations during fair hearings when required
check_circleParticipate in Inter-Rater Reliability audits to ensure consistency and quality
check_circleEnsure reviews meet standards for clear documentation, regulatory compliance, and sound decision-making
check_circleParticipate in physician-to-physician discussions regarding potential denials

Requirements

verifiedActive, current, unrestricted MD or DO license in the District of Columbia
verifiedBoard Certification
verifiedMinimum of 7 years of clinical practice experience preferred

Nice to Have

Clinical experience or board certification in Developmental and Behavioral Pediatrics. Current or recent clinical practice in Developmental and Behavioral Pediatrics. Prior utilization management, peer review, or appeals experience. Minimum of 7 years of clinical practice experience.

Benefits & Perks

check_circleMedical, dental and vision insurancecheck_circlePaid time off for vacation, illness and volunteeringcheck_circleRetirement savings plan with employer contributioncheck_circleAdoption financial assistancePaid parental leave

Skills, education and keywords

Skills: MD, Do, Developmental And Behavioral Pediatrics, Medicaid, Workers' Compensation, Utilization Management, Peer Review, Appeals, Fair Hearings, Inter-Rater Reliability Audits.

Education: MD or DO required.

Frequently asked questions about Medical Consultant Reviewer- Pediatrician PRN D.C. at Comagine Health

What does a Medical Consultant Reviewer- Pediatrician PRN D.C. at Comagine Health do?expand_more

Day-to-day, the Medical Consultant Reviewer- Pediatrician PRN D.C. at Comagine Health will perform clinical reviews and appeals utilizing pediatrician expertise; apply clinical judgment and evidence-based guidelines to render medical necessity determinations; provide clinical subject matter expertise to utilization management staff and case managers; and represent clinical determinations during fair hearings when required.

What are the requirements for this Medical Consultant Reviewer- Pediatrician PRN D.C. role?expand_more

To qualify for the Medical Consultant Reviewer- Pediatrician PRN D.C. at Comagine Health position, applicants should have: Active, current, unrestricted MD or DO license in the District of Columbia; Board Certification; and Minimum of 7 years of clinical practice experience preferred.

Where is the Medical Consultant Reviewer- Pediatrician PRN D.C. role at Comagine Health located?expand_more

Medical Consultant Reviewer- Pediatrician PRN D.C. at Comagine Health is based in 1628, 5th Street Northwest, Logan Circle/Shaw, Ward 2, Washington, District of Columbia, 20001, United States. This is a remote role.

Is this Medical Consultant Reviewer- Pediatrician PRN D.C. job remote, hybrid, or on-site?expand_more

Comagine Health has listed this Medical Consultant Reviewer- Pediatrician PRN D.C. role as remote.

How much experience is required for this Medical Consultant Reviewer- Pediatrician PRN D.C. role?expand_more

Medical Consultant Reviewer- Pediatrician PRN D.C. at Comagine Health typically requires 7+ years of relevant experience at the senior level.

What skills do you need for the Medical Consultant Reviewer- Pediatrician PRN D.C. role at Comagine Health?expand_more

Key skills for Medical Consultant Reviewer- Pediatrician PRN D.C. at Comagine Health include MD; Do; Developmental And Behavioral Pediatrics; Medicaid; Workers' Compensation; Utilization Management; Peer Review; and Appeals.

What education is required for Medical Consultant Reviewer- Pediatrician PRN D.C. at Comagine Health?expand_more

Educational requirements for this role: MD or DO required.

What category does the Medical Consultant Reviewer- Pediatrician PRN D.C. role belong to?expand_more

Medical Consultant Reviewer- Pediatrician PRN D.C. at Comagine Health is part of the healthcare & nursing job category on Recrutus.

Medical Consultant Reviewer- Pediatrician PRN D.C.