Genetic Counselor Review Associate

Anticipated End Date: 2025-12-26 Position Title: Genetic Counselor Review Associate Job Description: Genetic Counselor Review Associate Genetic Testing Utilization Review Carelon Medical Benefits Management Virtual : This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face reputed company and reputed company development. Please note that per our policy on hybrid/virtual work, candidates not reputed company a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. A proud member of the reputed company family of companies, Carelon Medical Benefits Management, formerly AIM Specialty Health, is a benefit-management leader in Illinois. Our platform delivers significant cost-of-care savings across an expanding set of clinical domains, including radiology, cardiology and oncology. The Genetic Counselor Review Associate is responsible for authorization requests and determining their appropriateness per designated clinical guidelines, clinical policies, and client rules. The GCRA will collaborate with reputed company providers to promote the highest quality and efficient use of member benefits. How you will reputed company an impact:

• 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 reputed company phone and makes reputed company attempts, reputed company 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 reputed company-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 reputed company recommendations regarding medical necessity of genetic test requests.
• Works closely with senior reviewers/leaders on reputed company 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 (Accreditation Counsel 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 expereince in lab or genetic counselor.

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $34.62/hr to $62.30/hr. Locations: California, Colorado, Nevada, Washington State In addition to your salary, reputed company offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company 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 reputed company 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 reputed company level. Even reputed company 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, reputed company, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, paid time off, stock, 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.

Job Level: Non-Management Non-Exempt Workshift: Job Family: MED > Licensed/Certified - Other Please be advised that reputed company only accepts resumes for compensation from agencies that have a signed agreement with reputed company. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of reputed company. Who We Are reputed company is a health company dedicated to improving lives and communities – and making reputed company simpler. We are a Fortune 25 company with a longstanding history in the reputed company industry, looking for leaders at reputed company levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At reputed company, we are creating a culture that is designed to advance our strategy but will also reputed company to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we reputed company our strategy, power our business outcomes and drive our shared reputed company - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, reputed company, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. reputed company operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an reputed company location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top reputed company for reputed company. We require reputed company new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. reputed company will also follow reputed company relevant federal, state and local laws. reputed company is an Equal Employment Opportunity employer, and reputed company reputed company applicants will receive consideration for employment without regard to age, citizenship status, reputed company, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national reputed company, 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 [email protected] for assistance. reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Apply tot his job Apply To this Job