Contract Physician – Medical Necessity Review (Genetic Testing)
New
USAContractMiddle
SalaryFixed payment per review
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Job Details
Requirements
- Active, unrestricted medical license in good standing.
- Board Certified in primary care specialty (Internal Medicine, Family Medicine, Pediatrics, or other relevant specialty).
- Medicare enrollment required.
- Ability to independently evaluate clinical documentation and render medical necessity determinations.
- Comfortable working in a fully asynchronous, technology-enabled workflow.
- Strong attention to detail and documentation accuracy.
- License in Kansas or Arkansas (along with residence in KS or AR) prioritized.
- Enrollment in Kansas or Arkansas Medicaid preferred, or willingness to enroll with administrative support.
- Telehealth or virtual care experience preferred.
- Prior experience with genetic testing preferred.
- Familiarity with payer medical necessity criteria preferred.
- Experience working with Medicaid populations preferred.
Responsibilities
- Review clinical documentation completed by a Genetic Counselor following patient history intake and pre-test counseling.
- Assess and determine medical necessity for genetic testing.
- Review and authorize testing orders and sign required supporting documents, when deemed appropriate.
- Ensure compliance with state regulations, payer requirements, and internal clinical protocols.
- Maintain HIPAA compliance and documentation standards.
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