[Hiring] Medical Consultant Reviewer @COMAGINE HEALTH

Role Description

Comagine Health is seeking a Board-Certified Internal Medicine, Emergency Medicine, or Family Practice physician 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 within Washington. Other areas can be considered (Oregon). This position is well suited for physicians looking for flexible, non-clinical work while maintaining an active or reduced clinical practice.

• Perform clinical reviews and appeals utilizing Internal Medicine, Emergency Medicine or Family Practice 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

• MD or DO required
• Active, current, unrestricted MD or DO license in the state of Washington or willing 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)

Company Description