PRN Medical Consultant Reviewer Family Medicine

Accountabilities: As a Medical Consultant Reviewer, you will apply your medical expertise and independent clinical judgment to ensure accurate, consistent, and evidence-based healthcare decisions. Your responsibilities will include: Conduct clinical reviews and appeals using expertise in Family Medicine, Internal Medicine, or Emergency Medicine. Apply evidence-based medical guidelines and clinical judgment to make timely, accurate, and defensible medical necessity determinations. Participate in physician-to-physician discussions, including consultations regarding potential coverage denials. Provide clinical subject matter expertise and guidance to utilization management teams, case managers, and healthcare consultants. Participate in fair hearings when required, representing and explaining clinical determinations. Take part in Inter-Rater Reliability (IRR) audits to assess review consistency and maintain quality standards. Ensure all clinical reviews meet documentation requirements, regulatory standards, and established decision-making guidelines. Maintain high standards of clinical integrity, objectivity, and professionalism throughout the review process. Requirements The ideal candidate is an experienced, board-certified physician with strong clinical judgment and the ability to conduct independent medical assessments in a remote, non-clinical environment. The following qualifications are expected: Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree required. Active, current, and unrestricted medical license in Washington State, or willingness to obtain one. Board certification in Family Medicine, Internal Medicine, or Emergency Medicine through ABMS or ABOS. At least 7 years of clinical practice experience preferred. Current or recent clinical practice experience in Family Medicine, Internal Medicine, or Emergency Medicine preferred. Previous experience in utilization management, peer review, or medical appeals is an advantage but not required. Strong clinical reasoning and the ability to apply evidence-based medical guidelines to complex cases. Excellent written and verbal communication skills, particularly when explaining clinical decisions and participating in physician consultations. Ability to maintain accurate documentation and ensure compliance with applicable regulatory and clinical standards. Ability to work independently, manage review assignments, and meet established deadlines. Comfortable using computers, phones, and virtual communication tools in a remote working environment. Reliable internet access and a dedicated home workspace with minimal distractions. Ability to sit for extended periods and communicate effectively throughout the workday. Willingness to travel occasionally for meetings, training, or other work-related activities, if required. Benefits Fully remote work arrangement within Washington State, with candidates from Oregon potentially considered. Flexible part-time or per-diem schedule of approximately 8–19 hours per week. Non-patient-facing role offering flexibility alongside an active or reduced clinical practice. Medical, dental, and vision insurance. Paid time off for vacation, illness, and volunteering. Retirement savings plan with employer contributions. Adoption financial assistance. Paid parental leave. Annual home office stipend to personalize and improve your remote workspace. Opportunities to contribute to meaningful healthcare quality improvement initiatives. Inclusive and supportive work environment focused on professional development and work-life balance. Reasonable accommodations for individuals with disabilities throughout the employment process and workplace.