*WORK FROM HOME*
Our laboratory utilization management program develops coverage policy around molecular and genomic tests, performs pre- and post-service medical necessity reviews, and evaluates claims with the goal of ensuring that our health plan clients provide appropriate coverage and reimbursement for genetic and genomic tests.
The Medical Director will join a team of genetic counselors and physicians who evaluate medical necessity requests for molecular and genomic testing with a focus on cases that do not clearly meet clinical criteria. In addition, the Medical Director will engage in peer to peer discussions with requesting physicians to clarify clinical information and to explain review outcome decisions. The Medical Director will also participate in research and policy development for emerging genetic tests.
Work Remote From Home!