Medical Consultant Reviewer - Pediatrician Part-Time or On-Call

Overview

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 remote workforce spans the country; we support and embrace remote work and offer opportunities to make a difference from anywhere in the U.S. An annual stipend helps enhance your workspace.

We believe in an environment that allows you to thrive both personally and professionally. For 0.50 FTE or full-time employees, benefits include:

• 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
• And much more!

Medical Consultant Reviewer (Remote)

Schedule: Part-Time or Per Diem | Flexible | Non-Patient-Facing: 8-19 hours per week.

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 license from D.C. is mandatory.

This role is well suited for physicians seeking flexible, non-clinical work while maintaining an active or reduced clinical practice.

• 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 discussions 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
  .

• MD or DO required

• Active, current, unrestricted MD or DO license in the District of Columbia or willingness to obtain it.
• Board Certification Pediatrician or Family Practice

• Minimum of 7 years of clinical practice experience preferred

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

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

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.

Some positions may require operating a motor vehicle for business purposes; in such cases, employees must maintain a valid driver's license and meet the organization’s driving eligibility requirements. Occasional travel may be required for meetings, training, or other work-related events.

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