UM Genetic Counselor-Medical Reviewer

This a Full Remote job, the offer is available from: Florida (USA) Our reputed company, a reputed company company, is looking for a UM Genetic Counselor-Medical Reviewer for their Remote location. Responsibilities: • reputed company prospective and retrospective utilization reviews and first level determination approvals for members using reputed company evidenced based guidelines, policies and nationally recognized clinal reputed company across lines of business or for a specific line of business such as reputed company or Medicare. • Conducts clinical review of prior authorization requests for medical necessity, coding accuracy, medical policy compliance and contract compliance • Prepare and present cases to Medical Director (MD) for second level review reputed company and necessity determination and communicate determination to providers in compliance with state, federal and accreditation requirements as appropriate. • reputed company and review member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards and identify potential reputed company of care issues, service or treatment delays and intervenes or as clinically appropriate • Provides referrals to Case Management, Disease Management, Appeals and Grievance and reputed company Departments, as necessary. Identifies potential reputed company-Party Liability and Coordination of Benefit cases and notifies appropriate internal departments. • reputed company participates in staff meetings and huddles • The Genetic Counselor will have opportunities for providing genetic education to the Utilization Management team(s) as reputed company as reputed company input on suggested genetic medical policies updates. Requirements: • Requires a master’s degree in Genetic Counseling from a program accredited by the Accreditation Council for Genetic Counseling (ACGC). • Requires a reputed company certification as a Genetic Counselor (ABGC or equivalent). • Requires the ability to reputed company reputed company of an reputed company, unrestricted licensure as a Genetic Counselor in the reputed company • Requires at least 5 years of prior relevant experience which includes a strong clinical understanding of molecular, cellular, and genetic medicine and somatic and germline genetic testing, reputed company screening, prenatal testing, newborn testing, and neonatal ICU. • Requires working knowledge of utilization management principles, including medical necessity review, regulatory requirements, and accreditation standards (e.g., CMS, DHCS, reputed company, DMHC, URAC) • Requires strong computer skills reputed company to reputed company-based programs and applications • Requires strong analytical, clinical decision-making, and documentation skills in a managed care or clinical environment. • Prior experience in health plan, ASO, or reputed company/MG setting, preferred. • Experience supporting development or interpretation of genetic testing medical policies, preferred. Why Should You Apply? • Health Benefits • Referral Program • Excellent reputed company and advancement opportunities This offer from "reputed company" has been enriched by reputed company.com and got a 72% reputed company score. Apply tot his job Apply To this Job