Medical Consultant Reviewer- Pediatrician PRN D.C.

Medical Consultant Reviewer

Comagine Health is 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 in the District of Columbia. Must be board certified with the District of Columbia.

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

Key Responsibilities

• 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.

Qualifications

Education

• MD or DO required
• Pediatrician. Clinical experience or board certification in Developmental and Behavioral Pediatrics preferred.

Licensure & Certification

• Active, current, unrestricted MD or DO license in the District of Columbia or willing to obtain this.
• Board Certification

Experience

• Minimum of 7 years of clinical practice experience preferred

Preferred

• Current or recent clinical practice in Developmental and Behavioral Pediatrics preferred
• Prior utilization management, peer review, or appeals experience (helpful but not required)

Equal Opportunity Employer

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

Physical Requirements & 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, 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.