Job Title Genetic Counselor Review AssociateLocation Virtual full‑time with required in‑person training sessions and occasional office attendance within a reasonable commuting distance.Role Overview This role enables associates to work virtually, promoting flexibility while ensuring face‑to‑face onboarding and skill development. The Genetic Counselor Review Associate is responsible for reviewing authorization requests for genetic testing and determining their appropriateness according to clinical guidelines, policies, and client rules.Responsibilities Conduct medical necessity reviews in adherence to guidelines and determine if clinical information meets criteria or requires physician review or override.Document clinical reviews and case interactions in the online database using standardized documentation style.Assist physician reviewers with clinical interpretation questions regarding medical necessity of test requests.Address questions from ordering provider offices via phone and make outreach attempts to obtain additional information needed for clinical determinations.Provide constructive feedback on Carelon guidelines as needed.Contribute to team projects to improve case review accuracy and efficiency, such as updating processes, reporting issues, and creating internal resources.Receive pre‑authorization requests from front‑line intake and determine if initial clinical information meets criteria or requires additional review for simple/routine cases.Work closely with medical directors to review and make recommendations regarding medical necessity of genetic test requests.Collaborate with senior reviewers/leaders on complex cases for utilization management, out‑of‑network appropriateness, and treatment appropriateness.Maintain confidentiality of patient and provider information.Minimum Requirements Master's or bachelor's degree in a genetics‑focused program from an ACGC-accredited program.ABGC board certification required.Preferred Qualifications Experience working in a cross‑functional team environment.Familiarity with reimbursement coding for genomic testing (CPT, ICD‑10‑CM).Two years of experience in a laboratory or as a genetic counselor.Equal Employment Opportunity Statement 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.#J-18808-Ljbffr
