Medical Consultant Reviewer – Pediatrician

Job not on LinkedIn

🕒 March 10

🏛️ District of Columbia – Remote

🏛️ District of Columbia – Remote

💵 $140 - $150 / hour

⏱ Part Time

🟠 Senior

🔴 Lead

💼 Consultant

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Comagine Health

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1973

💼 Consulting

🏥 Healthcare

🤝 Non-profit

Consulting • Healthcare • Non-profit

Comagine Health is a national nonprofit health care consulting organization that partners with providers, payers, public agencies, community organizations and consumers to improve health care quality, equity, and outcomes. It offers systemwide quality improvement, care management, data solutions, research and evaluation, and COVID-19 response services, using health information exchange and health IT to inform public health surveillance and program design. Comagine focuses on supporting community health, behavioral health, and patient-centered initiatives through technical assistance, evaluation, and collaborative systems-level work.

📋 Description

• 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. • 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.

🎯 Requirements

• MD or DO required • Pediatrician • Clinical experience or board certification in Developmental and Behavioral Pediatrics preferred • Active, current, unrestricted MD or DO license in the District of Columbia or willing to obtain this • Minimum of 7 years of clinical practice experience preferred • Prior utilization management, peer review, or appeals experience (helpful but not required)

🏖️ Benefits

• 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!