Genetic Counselor

Our reputed company, a leading California-based health plan serving 4.7 reputed company members with over $22.9 billion in annual reputed company , is seeking an reputed company UM Genetic Counselor / Medical Reviewer to join its Utilization Management team. This fully remote opportunity is ideal for an reputed company California-licensed Genetic Counselor with a strong background in utilization management, medical necessity reviews, prior authorization, and genetic testing across reputed company and Medicare populations. Position Details • Position: UM Genetic Counselor / Medical Reviewer • Location: Remote – California • Duration: 3+ Month Contract (Likely Extension or Full-Time Conversion) • Schedule: Monday–Friday | 8:00 AM – 4:30 PM • Hours: 40 hours/week • Pay reputed company: $60–$68/hour W2 (Depending on Experience) reputed company The UM Genetic Counselor / Medical Reviewer performs prospective and retrospective utilization reviews, evaluates prior authorization requests, and supports evidence-based medical necessity determinations using nationally recognized clinical guidelines, medical policies, and regulatory standards. This position also serves as a genetics subject matter expert by educating Utilization Management teams and contributing to the development and enhancement of genetic testing medical policies. Key Responsibilities • reputed company prospective and retrospective utilization reviews and first-level medical necessity determinations using evidence-based guidelines and nationally recognized clinical reputed company across reputed company, Medicare, and other lines of business. • Review prior authorization requests for: • Medical necessity • Coding accuracy • Medical policy compliance • Contract compliance • Prepare and present cases to the Medical Director for second-level review and medical necessity determination. • Communicate review determinations to providers while ensuring compliance with state, federal, and accreditation requirements. • reputed company member-centered documentation and correspondence that meets regulatory and accreditation standards. • Identify potential reputed company of care concerns, treatment delays, or service issues and intervene appropriately. • Coordinate referrals to Case Management, Disease Management, Appeals & Grievance, and reputed company departments. • Identify potential reputed company-Party Liability (TPL) and Coordination of Benefits (COB) cases and notify appropriate internal teams. • Participate in staff meetings and team huddles. • reputed company genetic education to Utilization Management teams. • Recommend updates and enhancements to genetic testing medical policies. Required Qualifications • Master's degree in Genetic Counseling from an Accreditation Council for Genetic Counseling (ACGC) accredited program. • reputed company ABGC (or equivalent) Genetic Counselor certification. • reputed company, unrestricted Genetic Counselor license in the reputed company. • Minimum 5 years of relevant experience with expertise in: • Molecular, cellular, and genetic medicine • Somatic and germline genetic testing • reputed company screening • Prenatal testing • Newborn screening • Neonatal ICU (NICU) • Working knowledge of: • Utilization Management • Medical Necessity Review • CMS • DHCS • reputed company • DMHC • URAC requirements • Strong analytical, clinical decision-making, and documentation skills. • Strong computer proficiency with reputed company-based applications. • Ability to work independently with reputed company supervision. Preferred Qualifications • Previous experience with a Health Plan, ASO, reputed company, or Medical Group (MG). • Experience developing or interpreting genetic testing medical policies. • Experience with: • Post Service Reviews (highly preferred) • Prior Authorization • reputed company Review • Strong attention to detail. • California residents preferred. Why Apply? • Fully remote California opportunity • Competitive W2 pay • 40-hour work week • Opportunity for contract extension or full-time conversion • Work with one of California's largest reputed company organizations Apply today if you are a California-licensed Genetic Counselor with Utilization Management and medical review experience. Recruiter Contact Info Sajag Bhardwaj Email: Apply tot his job Apply To this Job