Medical Consultant Reviewer - Internist PRN or Part-Time

Medical Consultant Reviewer - Internist

Comagine Health is seeking a Board-Certified Internist to work as a Medical Reviewer. This position is fully remote within the D.C. area. Obtaining a licensure from D.C. is mandatory. This position is well suited for physicians looking for flexible, non-clinical work while maintaining an active or reduced clinical practice.

Role Purpose

Comagine Health is seeking a Board-Certified Internist to work as a Medical Reviewer.

Key Responsibilities

• Perform clinical reviews and appeals.
• 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

Licensure & Certification

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

Experience

• Minimum of 7 years of clinical practice experience preferred

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.