Internal Medicine, ER, Family Practice Med, Consultant Reviewer
Qualis Health
Seattle, WA(remote)
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JOB DETAILS
SALARY
$137–$145 Per Hour
JOB TYPE
Part-time, Employee
SKILLS
Case Management, Clinical Medicine, Clinical Validation, Consulting, Documentation Standards, Emergency Medicine, Family Medicine, Healthcare, Internal Medicine, Internal Rate of Return (IRR), Medicaid, Physician Credential, Regulatory Compliance, Time Management, Utilization Management, Worker's Compensation
LOCATION
Seattle, WA
POSTED
30+ days ago
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.
Qualifications
Education
MD or DO required
Licensure & Certification
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)
Experience
Minimum of 7 years of clinical practice experience preferred
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)
Equal Employment Opportunity Employment Comagine Health is an Equal Employment Opportunity/Affirmative Action Employer that embraces and practices diversity, reflecting the communities we serve. We encourage minorities, protected veterans and individuals with disabilities to apply.
About the Company
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