Genetic Counselor Reviewer
| Company | Elevance Health |
|---|---|
| Location | Canoga Park, Los Angeles, CA, USA |
| Salary | $55.79 – $66.95 |
| Type | Full-Time |
| Degrees | Master’s |
| Experience Level | Mid Level |
Requirements
- Requires MA/MS from an ACGC (Accreditation Counsel for Genetic Counseling) accredited program, and a minimum 3 years of experience in clinical genetics and/or diagnostic laboratory; or any combination of education and experience, which would provide an equivalent background.
- Active, unrestricted genetic counselor license is required in applicable states.
- ABGC (American Board of Genetic Counseling) board certification required.
Responsibilities
- Receiving authorization requests for genetic tests from front-line intake.
- Conducting medical necessity review in adherence to guidelines and determining whether clinical information presented meets medical necessity criteria or requires physician review or override.
- Clearly and concisely documenting clinical review and other case interactions in online database in adherence to our standardized documentation style.
- Assisting physician reviewers with clinical interpretation questions regarding medical necessity of test requests.
- Addressing clinical questions received via incoming call from ordering providers and triaging calls when appropriate. Occasionally performing callouts to case submitters to obtain missing clinical information.
- Providing specific constructive feedback on Carelon guidelines.
- Maintaining confidentiality of patient and provider specific information.
- Contributing to team projects aimed to ensure case review accuracy and efficiency, such as updating case review processes, reporting issues, and creating internal case review resources.
Preferred Qualifications
- Motivation to exceed departmental metrics.
- Active, unrestricted genetic counselor license, especially in Florida, Georgia, Indiana, and/or Kentucky.
- Experience in utilization management and/or reimbursement coding for genetic testing.
- Experience with somatic oncology testing a plus.
- West Coast business hours are preferred, but not essential.
- Highly detailed-oriented.
- Escalates appropriate concerns or discrepancies.
- Works well both independently and as part of a team.
- Must be flexible and adaptable.