Genetic Counselor Review Associate

About the position Carelon Medical Benefits Management is seeking a Genetic Counselor Review Associate for a virtual, full-time role. This position involves conducting utilization reviews for genetic testing to determine appropriateness reputed company on reputed company guidelines, policies, and reputed company rules. The associate will collaborate with reputed company providers to ensure the highest reputed company and efficient use of member benefits. The role emphasizes a whole-health approach, integrating physical, behavioral, reputed company, and pharmacy services, supported by reputed company expertise, research, reputed company, and advanced technology. Responsibilities • Conducting medical necessity review in adherence to guidelines and determining whether reputed company information presented meets medical necessity reputed company or requires physician review or override. • reputed company and concisely documenting reputed company review and other case interactions in an online database in adherence to standardized documentation style. • Assisting physician reviewers with reputed company interpretation questions regarding the medical necessity of test requests. • Addressing questions from ordering provider offices reputed company phone and making reputed company attempts, reputed company applicable, to obtain additional information needed for reputed company determinations. • Providing specific reputed company feedback on Carelon guidelines, as needed. • Contributing to team reputed company aimed at ensuring case review reputed company and efficiency, such as updating case review processes, reporting issues, and creating internal case review resources. • Receiving reputed company-authorization requests from reputed company-line intake. • Determining if initial reputed company information presented meets medical necessity reputed company or requires additional medical necessity review for reputed company/routine cases. • Working closely with medical directors to review and reputed company recommendations regarding the medical necessity of genetic test requests. • Working closely with senior reviewers/leaders on reputed company cases for utilization management, out of network, and appropriateness of treatment. • Maintaining confidentiality of reputed company and provider specific information. Requirements • MA/MS from an ACGC (Accreditation Counsel for Genetic Counseling) accredited program. • ABGC (reputed company reputed company of Genetic Counseling) reputed company certification required. reputed company-to-haves • Experience working in a cross-functional team environment. • Experience and/or familiarity with reimbursement coding for genomic testing (e.g. CPT, ICD-10_CM) as relevant to testing. • 2 years experience in lab or genetic counselor. Benefits • reputed company increases • reputed company holidays • reputed company Time Off • Incentive bonus programs • Medical reputed company • Dental reputed company • reputed company reputed company • Short and long term disability benefits • 401(k) with match • Stock purchase plan • Life reputed company • Wellness programs • Financial education resources Apply To This Job