Genetic Counselor

This job involves conducting utilization reviews and determining approvals for members using evidence-based guidelines and clinical criteria, ensuring compliance with medical policies and contracts. It also includes presenting cases to a Medical Director for oversight, communicating determinations to providers and members, and maintaining documentation in compliance with regulations. Additionally, the role involves identifying quality of care issues, making referrals to various departments, and participating in team meetings. The Genetic Counselor in this role may also contribute to genetic education and policy updates for the UM team.

Pay- $36.67- $38.72
8-5 M-F PST
Temp-to-hire

Main Duties:

• Perform utilization reviews and determine approvals for members using evidence-based guidelines, policies, and clinical criteria
• Conduct clinical review of prior authorization requests for medical necessity, coding accuracy, and policy compliance
•  Present cases to Medical Director for oversight and determination of medical necessity
• Communicate determinations to providers and members in compliance with regulatory requirements
• Develop and review member documentation reflecting determinations and identify potential quality of care issues
• Provide referrals to Case Management, Disease Management, Appeals and Grievance, and Quality Departments as needed
• Identify potential Third-Party Liability and Coordination of Benefit cases and notify appropriate departments
• Actively participate in staff meetings and huddles
• Provide genetic education to the UM team and contribute to genetic medical policy updates

Priority Skills

• Master's degree in Genetic Counseling from an ACGC-accredited program
• Current Genetic Counselor Certification
• 3-5 years of relevant experience in molecular, cellular, and genetic medicine
• Strong understanding of somatic and germline genetic testing, carrier screening, prenatal testing, newborn testing, and neonatal ICU
• Proficiency in Windows-based computer programs and applications
  

Wollborg Michelson Recruiting is an Equal Opportunity Employer and prohibits discrimination of any kind. We ensure job offers are made based of one’s employment experience, skills, and qualifications, regardless of race, gender, ethnic origin, or any other classification protected by law. All applicants must furnish proper identification to prove their legal right to work in the US upon a job offer. We participate in E-Verify to confirm one’s right to work in the US. Wollborg Michelson Recruiting does not provide sponsorship for an employment-based visa status. All applicants must also provide proof of COVID Vaccination when requested, except where prohibited by law.

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