Comagine Health
This role involves performing clinical reviews and appeals using expertise in Internal Medicine, Emergency Medicine, or Family Practice across Medicaid, Workers’ Compensation, and private healthcare products. The position requires applying evidence-based medicine and clinical judgment to make timely medical necessity determinations and participating in physician-to-physician discussions and fair hearings.
Key Responsibilities
- • 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.
Required
- • MD or DO required
- • Active, current, unrestricted MD or DO license in the state of Washington or willing to obtain this.
- • Board Certification Internal Medicine, Emergency Medicine or Family Practice (ABMS or ABOS)
Preferred
- • Minimum of 7 years of clinical practice experience preferred
- • Current or recent clinical practice in Internal, Emergency Medicine or Family Practice
- • Prior utilization management, peer review, or appeals experience (helpful but not required)
Schedule: Part-Time or Per Diem | Flexible | Non-Patient-Facing : 8-19 hours per week.
Role Purpose
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.
Key Responsibilities
- 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.
Education
- MD or DO required
- Active, current, unrestricted MD or DO license in the state of Washington or willing to obtain this.
- Board Certification 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
- Prior utilization management, peer review, or appeals experience (helpful but not required)
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