Board-certified internists in this role perform non-patient-facing medical reviews and appeals, using clinical judgment and evidence-based guidelines to make medical necessity determinations. The work is fully remote and best suited to physicians who want flexible, part-time or per diem clinical consulting while maintaining an active or reduced practice. It also includes physician-to-physician discussions, support for utilization management staff and case managers, and participation in hearings and quality audits.
Key Responsibilities
- Perform clinical reviews and appeals for medical necessity determinations.
- Apply evidence-based guidelines and clinical judgment to support timely, defensible decisions.
- Participate in physician-to-physician discussions related to potential denials.
- Provide clinical subject matter expertise to utilization management staff, case managers, and consultants.
- Participate in fair hearings and represent clinical determinations when required.
- Take part in inter-rater reliability audits to support consistency and quality.
- Ensure documentation is clear, compliant, and supports sound decision-making.
Required
- MD or DO degree.
- Active, current, unrestricted District of Columbia medical license, or willingness to obtain one.
- Board certification in Internal Medicine.
- At least 7 years of clinical practice experience preferred by the employer.
Preferred
- Prior utilization management experience.
- Prior peer review experience.
- Prior appeals experience.
Benefits & Perks
- Fully remote work within the D.C. area.
- Flexible part-time or per diem schedule, 8-19 hours per week.
- Annual stipend to support a home workspace.
- Medical, dental, and vision insurance for eligible employees.
- Paid time off for vacation, illness, and volunteering for eligible employees.
- Retirement savings plan with employer contribution for eligible employees.
- Adoption financial assistance for eligible employees.
- Paid parental leave for eligible employees.