PRN Medical Consultant Reviewer – Family Medicine

🔥 8 minutes ago

☕ Washington – Remote

☕ Washington – Remote

💵 $137 - $145 / hour

⏱ Part Time

🟠 Senior

🔴 Lead

👻 Ghost score 2%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.Why this score:

• Just posted.
• Jobs at this company usually fill in 70 days.

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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 across Medicaid, Workers’ Compensation, and private healthcare products • Apply clinical judgment and evidence-based guidelines to render timely, defensible medical necessity determinations • Participate in physician-to-physician discussions, including potential denials • Provide clinical subject matter expertise to utilization management staff, case managers, and consultants • Participate in fair hearings and represent clinical determinations when required • Take part in Inter-Rater Reliability audits to ensure consistency and quality • Ensure reviews meet standards for clear documentation, regulatory compliance, and sound decision-making

🎯 Requirements

• MD or DO required • Active, current, unrestricted MD or DO license in the state of Washington or willingness to obtain this • Board Certification in Internal Medicine, Emergency Medicine or Family Practice (ABMS or ABOS) • Minimum of 7 years of clinical practice experience preferred • Current or recent clinical practice in Internal, Emergency Medicine or Family Practice preferred • Prior utilization management, peer review, or appeals experience helpful but not required • Reliable internet access and a home workspace free from significant distractions • Ability to sit for extended periods and communicate effectively • Valid driver’s license and driving eligibility requirements where operating a motor vehicle for business purposes is 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 • Annual stipend for workspace enhancements • Flexible remote work • Work-life balance • Reasonable accommodations for individuals with disabilities

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