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.
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). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
