Elevance Health
Genetic Counselor Review Associate
Elevance Health is seeking a dedicated Associate to review genetic test requests and ensure the highest quality of member care.
Base Pay Range $34.62/hr – $62.30/hr
Virtual Work Environment This role is fully virtual full‑time with the exception of required in‑person training sessions. The position offers maximum flexibility and autonomy, promoting productivity, work‑life integration, and essential face‑to‑face onboarding.
How You Will Make An Impact
Conduct medical necessity reviews in adherence to guidelines and determine whether clinical information meets medical necessity criteria or requires physician review or override.
Document clinical reviews and case interactions in an online database in accordance with 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 specific constructive feedback on Carelon guidelines as needed.
Contribute to team projects focused on case review accuracy and efficiency, including process updates, issue reporting, and internal resource creation.
Receive pre‑authorization requests from front‑line intake.
Determine if initial clinical information meets medical necessity criteria or requires additional review for simple/routine cases.
Collaborate with medical directors to review and make recommendations regarding medical necessity of genetic test requests.
Work closely with senior reviewers/leaders on complex cases for utilization management, out‑of‑network decisions, and treatment appropriateness.
Maintain confidentiality of patient and provider information.
Minimum Requirements
MA/MS from an ACGC (Accreditation Council for Genetic Counseling) accredited program.
ABGC (American Board of Genetic Counseling) board certification required.
Preferred Skills, Capabilities, and Experiences
Experience working in a cross‑functional team environment preferred.
Experience and/or familiarity with reimbursement coding for genomic testing (e.g., CPT, ICD‑10‑CM) as relevant to testing preferred.
2 years experience in a laboratory or as a genetic counselor.
Locations
California
Colorado
Nevada
Washington State
Elevance Health offers a comprehensive benefits package, incentive and recognition programs, an equity stock purchase plan, and 401(k) contributions, subject to eligibility. The Company is committed to ensuring equal pay opportunities for all employees, complying with federal, state, and local pay equity laws.
Elevance Health is an Equal Employment Opportunity employer. Qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other protected characteristic. Applicants who require accommodations in the job application process may contact
elevancehealthjobssupport@elevancehealth.com .
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Base Pay Range $34.62/hr – $62.30/hr
Virtual Work Environment This role is fully virtual full‑time with the exception of required in‑person training sessions. The position offers maximum flexibility and autonomy, promoting productivity, work‑life integration, and essential face‑to‑face onboarding.
How You Will Make An Impact
Conduct medical necessity reviews in adherence to guidelines and determine whether clinical information meets medical necessity criteria or requires physician review or override.
Document clinical reviews and case interactions in an online database in accordance with 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 specific constructive feedback on Carelon guidelines as needed.
Contribute to team projects focused on case review accuracy and efficiency, including process updates, issue reporting, and internal resource creation.
Receive pre‑authorization requests from front‑line intake.
Determine if initial clinical information meets medical necessity criteria or requires additional review for simple/routine cases.
Collaborate with medical directors to review and make recommendations regarding medical necessity of genetic test requests.
Work closely with senior reviewers/leaders on complex cases for utilization management, out‑of‑network decisions, and treatment appropriateness.
Maintain confidentiality of patient and provider information.
Minimum Requirements
MA/MS from an ACGC (Accreditation Council for Genetic Counseling) accredited program.
ABGC (American Board of Genetic Counseling) board certification required.
Preferred Skills, Capabilities, and Experiences
Experience working in a cross‑functional team environment preferred.
Experience and/or familiarity with reimbursement coding for genomic testing (e.g., CPT, ICD‑10‑CM) as relevant to testing preferred.
2 years experience in a laboratory or as a genetic counselor.
Locations
California
Colorado
Nevada
Washington State
Elevance Health offers a comprehensive benefits package, incentive and recognition programs, an equity stock purchase plan, and 401(k) contributions, subject to eligibility. The Company is committed to ensuring equal pay opportunities for all employees, complying with federal, state, and local pay equity laws.
Elevance Health is an Equal Employment Opportunity employer. Qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other protected characteristic. Applicants who require accommodations in the job application process may contact
elevancehealthjobssupport@elevancehealth.com .
#J-18808-Ljbffr