Job Description
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. They are seeking a Board-Certified Internist to work as a Medical Reviewer, performing clinical reviews and applying clinical judgment to ensure quality care delivery. 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 • 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 • And much more! 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 Apply tot his job
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