Clinical Medical Review

Provides clinical genetic counseling and supports genetic testing review, utilization management, case management, prior authorization, concurrent review, and post-service review activities. Clinical expertise in somatic and germline genetic testing, carrier screening, prenatal testing, newborn testing, and neonatal intensive care.

Genetic Counselor
Job Summary

Provides clinical genetic counseling and supports genetic testing review, utilization management, case management, prior authorization, concurrent review, and post-service review activities.

Responsibilities

• Apply clinical knowledge of molecular, cellular, and genetic medicine to evaluate genetic testing and related services.
• Perform medical necessity reviews and support utilization management activities.
• Review genetic testing requests, including carrier screening, prenatal testing, newborn testing, and neonatal intensive care cases.
• Support the development and interpretation of genetic testing medical policies.
• Complete clinical documentation and decision-making in a managed care or clinical environment.
• Support case management, prior authorization, concurrent review, and post-service review processes.

Requirements

• Master s degree in Genetic Counseling from a program accredited by the Accreditation Council for Genetic Counseling.
• Current certification as a Genetic Counselor through the American Board of Genetic Counseling or an equivalent organization.
• Active, unrestricted genetic counselor licensure.
• At least five years of relevant experience, including genetic medicine and genetic testing.
• Working knowledge of utilization management principles, medical necessity review, regulatory requirements, and accreditation standards.
• At least three years of case management experience.
• Registered Nurse or Licensed Vocational Nurse experience with a minimum of two years of clinical experience.
• Experience with prior authorization, concurrent review, and post-service review.
• Strong computer skills with Windows-based programs and applications.
• Strong analytical, clinical judgment, decision-making, and documentation skills.

Summary Qualification

• Clinical expertise in somatic and germline genetic testing, carrier screening, prenatal testing, newborn testing, and neonatal intensive care.
• Experience in managed care, health plan, administrative services, or integrated practice environments.
• Experience supporting genetic testing medical policy development or interpretation is preferred.
• Prior authorization experience is preferred.

Skill

• Genetic counseling and clinical genetic medicine
• Utilization management and medical necessity review
• Case management and clinical documentation
• Prior authorization, concurrent review, and post-service review
• Clinical judgment and analytical decision-making
• Windows-based computer applications
• Topaz and IBM FileNet

 

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.