Genetic Counselor Reviewer (contract)

Job ID: JP00047073

Anticipated Start Date: 12/16/2026

Please note this is the target date and is subject to change. BCForward will send official notice ahead of a confirmed start date.

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

Responsible for conducting pre-authorization, out of network and appropriateness of genetic tests by utilizing appropriate policies, clinical and department guidelines. Collaborate with healthcare providers to promote the most appropriate, highest quality and effective use of genetic testing to ensure quality member outcomes, and to optimize member benefits.

Primary duties may include but are not limited to:

-

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.

-

Coordinates with providers about the process and provides updates on cases reviewed.

-

Notifies ordering physician or rendering service provider office of the pre-authorization determination decision.

-

Documents the results of the initial clinical review and determination in the pre-certification computer system.

-

Conducts initial medical necessity review of out of network (OON) pre-authorization requests for services requested outside of the client health plan network.

-

Conducts review of grievance and appeals requests and provides summarization to Medical Directors.

-

Maintains confidentiality of patient and provider specific information.

-

Develops telephone service standards to meet departmental performance metrics.

-

Assists Medical Directors with clinical interpretation questions of denial recommendations.

-

Performs review of medical records and attachments.

-

Contacts providers to obtain and or clarify information.

Requirements:

-

Requires MA/MS from an ACGC (Accreditation Counsel for Genetic Counseling) accredited program, and a minimum 3 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. (Note: The following distinctions are not required for posting. Medical necessity reviews are conducted per clinical guidelines and incumbents do not deviate from guidelines. Authorization approvals are system driven and any reviews that do not meet clinical guidelines as stated are sent to the medical director for review.)..

Job Type: Contract

Additional Details:

-

9am- 5pm ( Mon- Fri). No weekends.

-

Work Location: 100% remote/virtual.

-

Candidates may reside anywhere in the United States(within a reasonable commute of a PulsePoint location);

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, contractors are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

About BCForward:

Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward's 6,000 consultants support more than 225 clients globally.

BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.

To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process.

This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.

Pay Rate Range

33.72 - 64.28 USD hourly

Additional Notes

The pay range is the range BCForward 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.

Benefits Information

BCForward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.

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 . This does not encompass additional non-standard compensation (e.g., benefits, paid time off, per diem, etc.).