Counselor leading dynamic group therapy sessions in a community - driven recovery environment. Engaging with members to promote their recovery and success in a supportive setting.
About the role
- Genetic Counselor Review Associate conducting medical necessity reviews for genetic testing at Carelon Medical. Collaborating with healthcare providers and ensuring compliance with clinical guidelines.
Responsibilities
- Conducting medical necessity review in adherence to guidelines
- Clearly documenting clinical review and other case interactions
- Assists physician reviewers with clinical interpretation questions
- Addresses questions from ordering provider offices via phone
- Provides specific constructive feedback on Carelon guidelines
- Contributes to team projects for accuracy and efficiency
- Receives pre-authorization requests from front-line intake
- Determines if initial clinical information meets medical necessity criteria
- Works closely with medical directors for recommendations
- Maintains confidentiality of patient and provider specific information
Requirements
- Requires MA/MS from an ACGC accredited program
- ABGC board certification required
- Experience working in a cross functional team environment preferred
- Experience and/or familiarity with reimbursement coding for genomic testing preferred
- 2 years experience in lab or genetic counseling
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
Job title
Job type
Experience level
Salary
Degree requirement
No Education Requirement
Location requirements
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