Genetic Counselor Review Associate

Carelon Medical Benefits Management
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 onboarding and skill development.
Please note that per our policy on hybrid/virtual work, candidates not within 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 Elevance Health 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 healthcare providers to promote the highest quality and efficient use of member benefits.

• Conduct medical necessity review in adherence to guidelines and determine whether clinical information presented meets medical necessity criteria or requires physician review or override.
• Clearly and concisely document clinical review and other case interactions in an online database in adherence to our standardized documentation style.
• Assist physician reviewers with clinical interpretation questions regarding medical necessity of test requests.
• Address questions from ordering provider offices via phone and make outreach attempts, when applicable, to obtain additional information needed for clinical determinations.
• Provide specific constructive feedback on Carelon guidelines, as needed.
• Contribute 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.
• Receive pre-authorization requests from front-line intake.
• Determine if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review for simple/routine cases.
• Work closely with medical directors to review and make recommendations regarding medical necessity of genetic test requests.
• Work closely with senior reviewers/leaders on complex cases for utilization management, out of network, and appropriateness of treatment.
• Maintain confidentiality of patient and provider specific information.

• MA/MS from an ACGC accredited program.
• ABGC board certification required.

• 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.

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.

• 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.

The salary range is the range Elevance Health 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 skill level. Even within 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, vested, 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.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes,…