Genetic Counseling Positions in Midwest

Genetic Counselor Reviewer

Elevance Health

Remote - Correction from link: The position will work remote and living within 50 miles of one of the Pulse Point office locations is no longer required.

Posted 04/28/2025

The genetic counselor reviewer (GCR) is responsible for authorization requests and determining their appropriateness per designated clinical guidelines, clinical policies, and client rules. The GCR will collaborate with healthcare providers to promote the highest quality and efficient use of member benefits.

Job Summary:

• Receiving authorization requests for genetic tests from front-line intake.

• 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.

• Assisting physician reviewers with clinical interpretation questions regarding medical necessity of test requests.

• Addressing clinical questions received via incoming call from ordering providers and triaging calls when appropriate. Occasionally performing callouts to case submitters to obtain missing clinical information.

• Providing specific constructive feedback on Carelon guidelines.

• Maintaining confidentiality of patient and provider specific information.

• Contributing 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.