[Hiring] Contract Physician – Medical Necessity Review (Genetic Testing) @Everlywell

Role Description

This role involves supporting asynchronous medical necessity review following a completed genetic counseling session. Services rendered under this role will support claims submitted to federal payers.

• 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 & sign required supporting documents, when deemed appropriate.
• Ensure compliance with state regulations, payer requirements, and internal clinical protocols.
• Maintain HIPAA compliance and documentation standards.

Qualifications

• Active, unrestricted medical license in good standing. License in Kansas or Arkansas (along with residence in KS or AR) prioritized.
• Medicare enrollment required. Enrollment in Kansas or Arkansas Medicaid preferred, or willingness to enroll with administrative support.
• Board Certified in primary care specialty (Internal Medicine, Family Medicine, Pediatrics, or other relevant specialty).
• 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.
• Telehealth or virtual care experience preferred.

Requirements

• Prior experience with genetic testing.
• Familiarity with payer medical necessity criteria.
• Experience working with Medicaid populations.

Benefits

• Fixed payment per review.
• Flexible schedule.
• 100% Remote.
• Professional Liability Insurance.