Everlywell - Contract Physician – Medical Necessity Review (Genetic Testing)

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