Note: The job is a remote job and is open to candidates in USA. Comagine Health is a national, mission-driven, nonprofit organization focused on health care quality consulting and improvement services. They are seeking a Board-Certified Internist to work as a Medical Reviewer, performing clinical reviews and applying clinical judgment to ensure quality patient outcomes.

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

Skills

• MD or DO required
• Active, current, unrestricted MD or DO license in the District of Columbia or willing to obtain this
• Board Certification Internist
• Minimum of 7 years of clinical practice experience preferred
• Prior utilization management, peer review, or appeals experience (helpful but not required)

Benefits

• An annual stipend gives you the freedom to enhance your workspace with options that suit your needs.
• 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

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