Associate Genetic Counselor Reviewer
Core
Conduct routine and simple reviews for genetic testing cases, performing initial medical necessity clinical screenings and determining if information meets criteria or requires additional review.
Role type
Associate Genetic Counselor Reviewer (Utilization Management)
Builds
Pre-authorization decisions and medical necessity determinations for genetic tests and related services
Domain
Healthcare / Genetic Counseling / Utilization Management
Deliverable
client delivery
Required skills
Medical necessity assessment, Policy and procedure adherence, Clinical standards application, Grievance and appeals review, Provider coordination, Documentation in pre-certification systems
Preferred skills
Reimbursement coding for genomic testing (CPT, ICD-10_CM), Cross-functional team collaboration
Technologies
Pre-certification computer systems
Responsibilities
Conduct initial medical necessity clinical screening for simple and routine review cases; Determine if initial clinical information meets medical necessity criteria; Work with medical directors to review and recommend on genetic test requests; Coordinate with providers regarding case processes and updates; Notify ordering physicians or service providers of pre-authorization decisions; Document review results in the pre-certification system; Review grievance and appeals requests for Medical Directors.
Seniority
Associate, Non-Management Non-Exempt