Responsible for leading a team of Genetic Counselors in a call center environment who collaborate with healthcare providers, and members to promote the most appropriate, highest quality and effective use of Genetic testing to ensure quality member outcomes, and to optimize member benefits. Leads the clinical screenings of preauthorization request to assess the medical necessity of Genetic testing procedures, out of network services, and appropriateness of treatment.
Primary duties may include, but are not limited to:
- Serves as a working team lead and team resource for any questions, problems, or issues.
- Receives pre-authorization requests from front-line intake.
- Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.
- Works closely with Medical Directors to review and make recommendations regarding medical necessity of genetic test requests.
- Assists Medical Directors with clinical interpretation questions of denial recommendations.
- Leads a Genetic Counselors team, including productivity standards, training and associate development.
- Monitors and resolves day-to-day client-specific issues and processes for the team.
- Ensures all cases are closed within established timeframe.
- Delegates and reassigns work to others to ensure effective and efficient utilization of resources.
- Provides input to management on annual associate performance reviews and assists with the resolution of staff issues.
- Ensures adherence to all company protocols, policies and procedures, and department standards. Serves as a technical resource for the team.
- Works closely with solutions, workforce management, cross team within operations and outside of operations, etc. to resolve issues.
- Requires MA/MS from an ACGC (Accreditation Counsel for Genetic Counseling) accredited program, and a minimum 4 years of experience in clinical genetics and/or diagnostic laboratory; or any combination of education and experience, which would provide an equivalent background.
- Active, unrestricted genetic counselor license is required in applicable states.
- ABGC (American Board of Genetic Counseling) board certification required.
- MS or PhD in Human Genetics, Molecular Biology, or equivalent experience preferred.
- Experience in medical review and/or utilization management preferred.
- Experience with oncology preferred.
- Experience with reimbursement coding for genomic testing preferred.
Applicable to Colorado Applicants Only:
Colorado Hourly Pay Range*: $36.00/hr - $53.00 Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.
We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealthinc.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact firstname.lastname@example.org for assistance.