Elevance Health
Genetic Counselor Reviewer
Elevance Health, Los Angeles, California, United States,
Anticipated End Date:
2024-11-18
Position Title:
Genetic Counselor Reviewer
Job Description:
The genetic counselor reviewer (GCR) is responsible for authorization requests and determining their appropriateness per designated clinical guidelines, clinical policies, and client rules. The GCR will collaborate with healthcare providers to promote the highest quality and efficient use of member benefits.
Location:
This position will work remote and must live within 50 miles of one of our Pulse Point office locations.
Hours:
11:30am CST to 8pm CST
How will you make an impact:
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.
Minimum 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.
Preferred Skills, Capabilities, and Experiences:
West coast business hours.
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.
Highly detailed-oriented.
Escalates appropriate concerns or discrepancies.
Works well both independently and as part of a team.
Must be flexible and adaptable.
Salary:
For candidates working in person or remotely in the below location(s), the salary range for this specific position is $51.83 to $62.19.
Locations:
California
In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
Job Level:
Non-Management Non-Exempt
Workshift:
Job Family:
MED > Licensed/Certified Allied Health Professional
Who We Are:
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work:
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation.
Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.
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2024-11-18
Position Title:
Genetic Counselor Reviewer
Job Description:
The genetic counselor reviewer (GCR) is responsible for authorization requests and determining their appropriateness per designated clinical guidelines, clinical policies, and client rules. The GCR will collaborate with healthcare providers to promote the highest quality and efficient use of member benefits.
Location:
This position will work remote and must live within 50 miles of one of our Pulse Point office locations.
Hours:
11:30am CST to 8pm CST
How will you make an impact:
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.
Minimum 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.
Preferred Skills, Capabilities, and Experiences:
West coast business hours.
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.
Highly detailed-oriented.
Escalates appropriate concerns or discrepancies.
Works well both independently and as part of a team.
Must be flexible and adaptable.
Salary:
For candidates working in person or remotely in the below location(s), the salary range for this specific position is $51.83 to $62.19.
Locations:
California
In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
Job Level:
Non-Management Non-Exempt
Workshift:
Job Family:
MED > Licensed/Certified Allied Health Professional
Who We Are:
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work:
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation.
Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.
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