Genetic Testing Physician

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🔥 0 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $152k - $217.2k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

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Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

📦 Logistics

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Consulting • Logistics • Healthcare Insurance

Gainwell Technologies is the nation’s leading provider of digital and cloud-enabled solutions across the human services and public health ecosystem. With a mission-driven approach, Gainwell serves clients in all 50 U. S. states, focusing on improving health outcomes and delivering intuitive, human-centered experiences. Their comprehensive suite of solutions includes Medicaid Enterprise modernization, data analytics, provider services, and pharmacy solutions, all designed to advance the future of healthcare and enhance community well-being.

📋 Description

• Serve as the physician subject matter expert for genetics, genomics, hereditary disorders, and genetic testing services • Review complex authorization requests, appeals, and medical necessity determinations related to molecular diagnostics, genomic testing, pharmacogenomics, and hereditary disease evaluations • Conduct peer-to-peer consultations with providers and apply evidence-based clinical criteria to support appropriate testing and treatment decisions • Provide clinical guidance to utilization management, quality, case management, and operational teams • Interpret and apply Medicaid regulations, medical policies, and national genetic testing guidelines to support program compliance • Collaborate with clients and internal stakeholders to improve healthcare outcomes, quality initiatives, and appropriate utilization of genetic testing services • Collaborate with providers, genetic counselors, laboratories, clients, and multidisciplinary healthcare teams • Participate in peer-to-peer reviews, complex case consultations, and medical necessity determinations related to genetic testing and precision medicine services • Contribute to clinical policy development, quality outcomes, and program effectiveness through clinical documentation review and evidence-based decision-making

🎯 Requirements

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) • Active, unrestricted U.S. medical license • Active, unrestricted license to practice medicine in California required • Board Certification in Medical Genetics and Genomics, Clinical Genetics, or a related specialty • Minimum of 5+ years of post-residency clinical experience in genetics, genomics, hereditary diseases, or genetic testing programs • Strong knowledge of molecular diagnostics, genomic testing, hereditary cancer syndromes, rare diseases, pharmacogenomics, and evidence-based clinical guidelines • Experience with Medicaid programs, utilization management, prior authorization, appeals, or medical review activities • Strong analytical, communication, and decision-making skills • Must perform work while located within the United States • Flexibility required as needed for the standard schedule

🏖️ Benefits

• Flexible hours • Work-life balance • Continuous learning and career development • Generous, flexible vacation policy • 401(k) employer match • Comprehensive health benefits • Educational assistance • Leadership and technical development academies