[Remote] Medical Consultant Reviewer - Internist PRN or Part-Time

Note: The job is a remote job and is open to candidates in USA. Comagine Health is a national, mission-driven, nonprofit organization focused on health care quality consulting and improvement services. They are seeking a Board-Certified Internist to work as a Medical Reviewer, performing clinical reviews and applying clinical judgment to ensure quality patient outcomes.ResponsibilitiesPerform clinical reviews and appealsApply clinical judgment and evidence-based guidelines to render timely, defensible medical necessity determinationsParticipate in physician-to-physician discussions, including those related to potential denialsProvide clinical subject matter expertise to utilization management staff, case managers, and consultantsParticipate in fair hearings, representing clinical determinations when requiredTake part in Inter-Rater Reliability (IRR) audits to ensure consistency and qualityEnsure reviews meet standards for clear documentation, regulatory compliance, and sound decision-makingSkillsMD or DO requiredActive, current, unrestricted MD or DO license in the District of Columbia or willing to obtain thisBoard Certification InternistMinimum of 7 years of clinical practice experience preferredPrior utilization management, peer review, or appeals experience (helpful but not required)BenefitsAn annual stipend gives you the freedom to enhance your workspace with options that suit your needs.Medical, dental and vision insurancePaid time off for vacation, illness and volunteeringRetirement savings plan with employer contributionAdoption financial assistancePaid parental leaveCompany OverviewComagine Health is a healthcare consulting firm & they work collaboratively with patients, providers, payers and other stakeholders. It was founded in 2018, and is headquartered in Portland, Oregon, USA, with a workforce of 201-500 employees. Its website is https://comagine.org/.