Contract Physician – Medical Necessity Review (Genetic Testing)
New
E
EverlywellHealthcare
100% RemoteContractMiddle
Salary not disclosed
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Job Details
Requirements
- Hold an active, unrestricted medical license in good standing.
- Hold a Kansas or Arkansas medical license and reside in Kansas or Arkansas; these candidates are prioritized.
- Have Medicare enrollment.
- Have Kansas or Arkansas Medicaid enrollment, or be willing to enroll with administrative support; enrollment is preferred.
- Be board certified in Internal Medicine, Family Medicine, Pediatrics, or another relevant primary care specialty.
- Be able to independently evaluate clinical documentation and make medical necessity determinations.
- Be comfortable working in a fully asynchronous, technology-enabled workflow.
- Demonstrate attention to detail and documentation accuracy.
- Telehealth or virtual care experience is preferred.
- Prior genetic testing experience is preferred.
- Familiarity with payer medical necessity criteria is preferred.
- Experience working with Medicaid populations is 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 appropriate.
- Ensure compliance with state regulations, payer requirements, and internal clinical protocols.
- Maintain HIPAA compliance and documentation standards.
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