UM Genetic Counselor - Medical Reviewer

Location: Remote MUST LIVE IN CALIFORNIA

Schedule: Monday-Friday, 8:00 AM - 4:30 PM PST

Overview

We are seeking an experienced Genetic Counselor - Medical Reviewer to support utilization management activities in a fast-paced healthcare environment. This role will be responsible for reviewing genetic testing and related medical services for medical necessity, coding accuracy, policy compliance, and regulatory adherence.

The ideal candidate will possess strong clinical genetics expertise, utilization management knowledge, sound clinical judgment, and the ability to work independently in a fully remote setting.

Key Responsibilities

• Perform prospective and retrospective utilization reviews and first-level determination approvals using evidence-based guidelines, medical policies, and nationally recognized clinical criteria.
• Review prior authorization requests for:
  • Medical necessity
  • Coding accuracy
  • Medical policy compliance
  • Contract compliance
• Prepare and present cases requiring secondary review to Medical Directors and assist with determination communications to providers.
• Develop clear, member-centered documentation and correspondence that meet regulatory and accreditation standards.
• Identify potential quality of care concerns, treatment delays, or service issues and take appropriate action.
• Provide referrals to Case Management, Disease Management, Appeals and Grievances, and Quality teams as appropriate.
• Identify potential Third-Party Liability (TPL) and Coordination of Benefits (COB) cases and communicate findings to relevant stakeholders.
• Participate in team meetings, huddles, and collaborative discussions.
• Provide genetic counseling expertise and educational support to utilization management teams.
• Contribute recommendations related to genetic testing policies and clinical guidelines.

Required Qualifications

• Master's Degree in Genetic Counseling from an Accreditation Council for Genetic Counseling (ACGC) accredited program.
• Current Genetic Counselor certification (ABGC or equivalent).
• Active, unrestricted Genetic Counselor license in the State of California.
• Minimum 5 years of relevant professional experience.
• Strong clinical knowledge of:
  • Molecular genetics
  • Cellular genetics
  • Genetic medicine
  • Somatic and germline testing
  • Carrier screening
  • Prenatal testing
  • Newborn screening
  • NICU genetics
• Working knowledge of utilization management principles and medical necessity review.
• Familiarity with healthcare regulatory and accreditation standards including:
  • CMS
  • DHCS
  • NCQA
  • DMHC
  • URAC
• Strong analytical, clinical decision-making, and documentation skills.
• Proficiency with Windows-based software and standard business applications.
• Ability to work independently with minimal supervision.

Preferred Qualifications

• Experience in a Health Plan, ASO, IPA, or Medical Group environment.
• Experience supporting development, review, or interpretation of genetic testing medical policies.
• Prior utilization management experience involving:
  • Post-Service Review
  • Prior Authorization Review
  • Concurrent Review
• California residency preferred.
• Strong attention to detail.

Preferred Candidate Profile

The ideal candidate will demonstrate:

• Excellent clinical judgment
• Strong computer proficiency
• Exceptional attention to detail
• Ability to manage competing priorities independently
• Effective written and verbal communication skills
• Experience working in a remote healthcare environment

Job Type & Location

This is a Contract to Hire position based out of Rancho Cordova, CA.

The pay range for this position is $50.00 - $60.00/hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: • Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave)

This is a fully remote position.

This position is anticipated to close on Aug 8, 2026.

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 20,000 consultants and 5,000 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. We are proud to be an Engineering News-Record (ENR) Top 500 Design Firm for our engineering design services and a ClearlyRated Best of Staffing® winner for both client and talent service.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.

San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.

Salary : $50 - $60