Associate Genetic Counselor, Reviewer

This is a fully remote position, open to applicants in Florida, +3 more states.

📋 Description

• Accept pre-authorization requests from front-line intake.

• Perform initial clinical screening for medical necessity pertaining to straightforward and routine genetic testing review cases.

• Assess whether the clinical information satisfies medical necessity criteria or necessitates further evaluation.

• Collaborate with medical directors to review and provide recommendations on genetic test requests.

• Assist senior reviewers and leaders with complex utilization management, out-of-network cases, and treatment appropriateness assessments.

• Liaise with providers regarding case processes and updates.

• Inform ordering physicians or service provider offices of pre-authorization outcomes.

• Record clinical review findings and decisions in the pre-certification computer system.

• Conduct initial medical necessity evaluations of out-of-network pre-authorization requests.

• Review grievance and appeals requests for Medical Directors.

• Ensure the confidentiality of patient and provider-specific information is maintained.

• Establish telephone service standards to achieve departmental performance metrics.

⛳️ Requirements

• MA/MS from an ACGC (Accreditation Counsel for Genetic Counseling) accredited program is required.

• ABGC (American Board of Genetic Counseling) board certification is mandatory.

• Previous experience and/or familiarity with reimbursement coding for genomic testing (e.g. CPT, ICD-10_CM) is preferred.

• Experience in a cross-functional team environment is preferred.

• Candidates must reside within a reasonable commuting distance from the job location(s), unless an accommodation is provided as required by law.

• New candidates in specific patient/member-facing positions must be vaccinated against COVID-19 and Influenza, unless they can provide an acceptable justification.

🏝️ Benefits

• Merit increases.

• Paid holidays.

• Paid Time Off.

• Incentive bonus programs.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• Short-term disability benefits.

• Long-term disability benefits.

• 401(k) with matching contributions.

• Stock purchase plan.

• Life insurance.

• Wellness programs.

• Financial education resources.

• Virtual full-time work, except during required in-person training sessions.