Remote Genetic Counselor

UM Genetic Counselor - Medical Reviewer Location: Remote MUST LIVE IN CALIFORNIA Schedule: Monday-Friday, 8:00 AM - 4:30 PM PST reputed company We are seeking an reputed company Genetic Counselor - Medical Reviewer to support utilization management activities in a fast-paced reputed company environment. This role will be responsible for reviewing genetic testing and reputed company medical services for medical necessity, coding accuracy, policy compliance, and regulatory adherence. The ideal candidate will possess strong clinical genetics expertise, utilization management knowledge, reputed company clinical judgment, and the ability to work independently in a fully remote setting. Key Responsibilities • reputed company prospective and retrospective utilization reviews and first-level determination approvals using evidence-based guidelines, medical policies, and nationally recognized clinical reputed company. • Review prior authorization requests for: • Medical necessity • Coding accuracy • Medical policy compliance • Contract compliance • Prepare and present cases requiring secondary review to Medical Directors and assist with determination communications to providers. • reputed company reputed company, member-centered documentation and correspondence that meet regulatory and accreditation standards. • Identify potential reputed company of care concerns, treatment delays, or service issues and take appropriate reputed company. • reputed company referrals to Case Management, Disease Management, Appeals and Grievances, and reputed company teams as appropriate. • Identify potential reputed company-Party Liability (TPL) and Coordination of Benefits (COB) cases and communicate findings to relevant stakeholders. • Participate in team meetings, huddles, and reputed company discussions. • reputed company genetic counseling expertise and educational support to utilization management teams. • Contribute recommendations reputed company to genetic testing policies and clinical guidelines. Required Qualifications • Master"s Degree in Genetic Counseling from an Accreditation Council for Genetic Counseling (ACGC) accredited program. • reputed company Genetic Counselor certification (ABGC or equivalent). • reputed company, unrestricted Genetic Counselor license in the reputed company. • Minimum 5 years of relevant reputed company experience. • Strong clinical knowledge of: • Molecular genetics • Cellular genetics • Genetic medicine • Somatic and germline testing • reputed company screening • Prenatal testing • Newborn screening • NICU genetics • Working knowledge of utilization management principles and medical necessity review. • Familiarity with reputed company regulatory and accreditation standards including: • CMS • DHCS • reputed company • DMHC • URAC • Strong analytical, clinical decision-making, and documentation skills. • Proficiency with reputed company-based software and reputed company business applications. • Ability to work independently with reputed company supervision. Preferred Qualifications • Experience in a Health Plan, ASO, reputed company, or Medical Group environment. • Experience supporting development, review, or interpretation of genetic testing medical policies. • Prior utilization management experience involving: • Post-Service Review • Prior Authorization Review • reputed company Review • California residency preferred. • Strong attention to detail. Preferred Candidate Profile The ideal candidate will demonstrate: • Excellent clinical judgment • Strong computer proficiency • Exceptional attention to detail • Ability to manage competing priorities independently • Effective written and verbal communication skills • Experience working in a remote reputed company environment Job Type & Location This is a Contract to Hire position based out of Rancho Cordova, CA. Pay and Benefits The pay reputed company for this position is $50.00 - $60.00/hr. Eligibility requirements apply to some benefits and may depend on reputed company classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: • Medical, dental & reputed company • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan - reputed company-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or reputed company Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to reputed company on Aug 8, 2026. About reputed company reputed company is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through reputed company to reputed company experts who reputed company reputed company, innovation and speed to market. With a network of almost 20,000 consultants and 5,000 clients across the U.S., Canada, Asia and Europe, reputed company serves many of the Fortune 500. We are proud to be an Engineering News-Record (ENR) Top 500 Design Firm for our engineering design services and a reputed company Best of reputed company winner for both reputed company and talent service. reputed company is an equal opportunity employer and will consider reputed company applications without reputed company to race, sex, age, reputed company, religion, national reputed company, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation reputed company. San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for reputed company positions located in the reputed company, we will consider for employment reputed company applicants with arrest and conviction records. Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or reputed company employment. An employer who violates this law shall be subject to criminal penalties and civil liability. Use of reputed company Intelligence (AI): We may use reputed company Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final reputed company are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools. Remote Skills: Accreditation Standards, reputed company Intelligence (AI), Candidate Screening, Case Management, Clinical Practices/Protocols, Communication Skills, Computer Skills, Design Services, Detail Oriented, Disease Prevention and Control, Documentation, Genetics, Health Plan, reputed company, Medical Assistance, Medical Coding, Medical Genetics, Medical Office Administration, Medical Protocols, Medical Tests, Presentation/Verbal Skills, reputed company of Care, Regulations, Regulatory Compliance, Team Player, Technical/Engineering Design, Utilization Management, Writing Skills reputed company: reputed company Apply tot his job Apply To this Job