Medical Consultant Reviewer- Pediatrician PRN D.C.

COMAGINE HEALTH•Washington, DC

11h•Remote

About The Position

Comagine Health is seeking a pediatrician. Clinical experience or board certification in Developmental and Behavioral Pediatrics preferred, 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 the District of Columbia. Must be board certified with the District of Columbia. This position is well suited for physicians looking for flexible, non-clinical work while maintaining an active or reduced clinical practice.

Requirements

MD or DO required
Pediatrician. Clinical experience or board certification in Developmental and Behavioral Pediatrics preferred.
Active, current, unrestricted MD or DO license in the District of Columbia or willing to obtain this.
Board Certification
Minimum of 7 years of clinical practice experience preferred

Nice To Haves

Current or recent clinical practice in Developmental and Behavioral Pediatrics preferred
Prior utilization management, peer review, or appeals experience (helpful but not required)

Responsibilities

Perform clinical reviews and appeals utilizing pediatrician 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.