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Contract Physician – Medical Necessity Review (Genetic Testing)

Everly Health

Role overview

Qualifications

  • Active, unrestricted medical license in good standing (Kansas or Arkansas preferred; residence in KS or AR).
  • Medicare enrollment is required.
  • Board Certified in a primary care specialty (Internal Medicine, Family Medicine, Pediatrics, or other relevant specialty).
  • Ability to independently evaluate clinical documentation and render medical necessity determinations.

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

About the company

Everly Health logo

Everly Health

Digital Health & Health Tech

Everlywell, PWNHealth, and Home Access Health Corp. are now Everly Health. We’ve formed Everly Health to improve the lives of millions with a fully integrated digital care platform for consumers and businesses. We continue to innovate in the space by delivering more care to more people on a seamless diagnostics-driven platform. We believe better healthcare is achieved when everyone has access to fully integrated digital care. That a person's life can transform if we meet people where they are and provide them with a pathway to affordable and actionable health insights. The way healthcare should be—centered around people.

Company details

IndustryDigital Health & Health Tech
Company size501 - 1000

Links

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Job description

PWN Remote Care Services, P.A. (PWN) is a telehealth practice facilitating access to high-quality, diagnostic-driven patient care. PWN is part of a provider network affiliated with Everlywell, a leading remote-based healthcare company. At PWN our mission is to enable access to diagnostic testing, treatment, and professional guidance that empowers individuals to improve their health. Our suite of services enables a broad spectrum of health industry clients to provide seamless access to diagnostic testing and related care interventions. We are a 50-state physician, registered nurse, and genetic counselor network with a strong care coordination and patient support team and technology infrastructure.

Our model integrates genetic counselors, physicians, and technology to ensure clinically appropriate and compliant genetic testing services. We are seeking physicians to support asynchronous medical necessity review following a completed genetic counseling session. Services rendered under this role will support claims submitted to federal payers. As such, strict adherence to documentation standards, medical necessity criteria, and applicable state and federal regulations is required.

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 & 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.

    • Ideal Experience
  • 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
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    Marcus Rivera

    Chief Revenue Officer

    m.rivera@company.com
    linkedin.com/in/marcusrivera
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