Associate Genetic Counselor, Reviewer

🔥 0 minutes ago

🐊 Florida, Ohio, +2 more states – Remote

🐊 Florida – Remote 🏈 Ohio – Remote 🏰 Missouri – Remote 🎸 Tennessee – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🛋️ Counselor

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Elevance Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 B2B

Healthcare • Healthcare Insurance • B2B

Elevance Health is transforming from a traditional health benefits organization into a lifetime trusted health partner, driven by a bold purpose to improve the health of humanity. With nearly 100,000 associates, they serve over 118 million people and utilize an integrated whole health approach supported by industry-leading capabilities and a digital health platform. Their mission includes redefining health, reimagining the health system, and strengthening communities.

📋 Description

• Receive pre-authorization requests from front-line intake • Conduct initial medical necessity clinical screening for simple and routine genetic testing review cases • Determine whether clinical information meets medical necessity criteria or requires additional review • Work with medical directors to review and make recommendations regarding genetic test requests • Support senior reviewers and leaders on complex utilization management, out-of-network, and appropriateness-of-treatment cases • Coordinate with providers about case processes and updates • Notify ordering physicians or rendering service provider offices of pre-authorization decisions • Document clinical review results and determinations in the pre-certification computer system • Conduct initial medical necessity reviews of out-of-network pre-authorization requests • Review grievance and appeals requests for Medical Directors • Maintain confidentiality of patient and provider-specific information • Develop telephone service standards to meet departmental performance metrics

🎯 Requirements

• MA/MS from an ACGC (Accreditation Counsel for Genetic Counseling) accredited program • ABGC (American Board of Genetic Counseling) board certification required • Experience and/or familiarity with reimbursement coding for genomic testing (e.g. CPT, ICD-10_CM) preferred • Experience working in a cross functional team environment preferred • Candidates must be within a reasonable commuting distance from the posting location(s), unless an accommodation is granted as required by law • New candidates in certain patient/member-facing roles must become vaccinated against COVID-19 and Influenza, unless they provide an acceptable explanation

🏖️ Benefits

• Merit increases • Paid holidays • Paid Time Off • Incentive bonus programs • Medical benefits • Dental benefits • Vision benefits • Short-term disability benefits • Long-term disability benefits • 401(k) + match • Stock purchase plan • Life insurance • Wellness programs • Financial education resources • Virtual full-time work, except for required in-person training sessions