Elevance Health
Genetic Counselor Review Associate
Elevance Health, Walnut Creek, California, United States, 94598
Genetic Counselor Review Associate
Join to apply for the Genetic Counselor Review Associate role at Elevance Health.
Base pay range $34.62/hr - $62.30/hr
Responsibilities
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.
Assists physician reviewers with clinical interpretation questions regarding medical necessity of test requests.
Addresses questions from ordering provider offices via phone and makes outreach attempts, when applicable, to obtain additional information needed for clinical determinations.
Provides specific constructive feedback on Carelon guidelines, as needed.
Contributes 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.
Receives pre-authorization requests from front-line intake.
Determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review for simple/routine cases.
Works closely with medical directors to review and make recommendations regarding medical necessity of genetic test requests.
Works closely with senior reviewers/leaders on complex cases for utilization management, out of network and appropriateness of treatment.
Maintains confidentiality of patient and provider specific information.
Minimum Requirements
Requires MA/MS from an ACGC accredited program.
ABGC 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 lab or genetic counselor.
Locations California, Colorado, Nevada, Washington State.
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.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
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. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
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Base pay range $34.62/hr - $62.30/hr
Responsibilities
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.
Assists physician reviewers with clinical interpretation questions regarding medical necessity of test requests.
Addresses questions from ordering provider offices via phone and makes outreach attempts, when applicable, to obtain additional information needed for clinical determinations.
Provides specific constructive feedback on Carelon guidelines, as needed.
Contributes 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.
Receives pre-authorization requests from front-line intake.
Determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review for simple/routine cases.
Works closely with medical directors to review and make recommendations regarding medical necessity of genetic test requests.
Works closely with senior reviewers/leaders on complex cases for utilization management, out of network and appropriateness of treatment.
Maintains confidentiality of patient and provider specific information.
Minimum Requirements
Requires MA/MS from an ACGC accredited program.
ABGC 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 lab or genetic counselor.
Locations California, Colorado, Nevada, Washington State.
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.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
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. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
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