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
Company Overview
Comagine Health is a healthcare consulting firm & they work collaboratively with patients, providers, payers and other stakeholders. It was founded in 2018, and is headquartered in Portland, Oregon, USA, with a workforce of 201-500 employees. Its website is https://comagine.org/.