Contract Physician, Genetic Testing Medical Necessity Review

About PWN and Everlywell

PWN Remote Care Services, P.A. (PWN) is a telehealth practice dedicated to 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. Our mission at PWN is to enable access to diagnostic testing, treatment, and professional guidance that empowers individuals to improve their health. We offer a comprehensive suite of services that allows a broad spectrum of health industry clients to provide seamless access to diagnostic testing and related care interventions. Our robust network includes physicians, registered nurses, and genetic counselors across all 50 states, supported by a strong care coordination, patient support team, and advanced technology infrastructure.

Our unique model integrates genetic counselors, physicians, and technology to ensure clinically appropriate and compliant genetic testing services. We are actively seeking physicians to join our team and support asynchronous medical necessity review following a completed genetic counseling session. Services rendered in this role will specifically support claims submitted to federal payers. Consequently, strict adherence to documentation standards, medical necessity criteria, and all applicable state and federal regulations is paramount.

Responsibilities of a Contract Physician, Genetic Testing Medical Necessity Review

• 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 rigorous documentation standards.

Qualifications

• Active, unrestricted medical license in good standing.
• License in Kansas or Arkansas (along with residence in KS or AR) is prioritized.
• Medicare enrollment is required. Enrollment in Kansas or Arkansas Medicaid is preferred, or a willingness to enroll with administrative support.
• Board Certified in a primary care specialty (Internal Medicine, Family Medicine, Pediatrics, or other relevant specialty).
• Demonstrated ability to independently evaluate clinical documentation and render medical necessity determinations.
• Comfortable working in a fully asynchronous, technology-enabled workflow.
• Possess strong attention to detail and a high level of documentation accuracy.
• Telehealth or virtual care experience is 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 work arrangement.
• Professional Liability Insurance coverage.

We leverage artificial intelligence (AI) tools to enhance various stages of our hiring process, including application review, resume analysis, and response assessment. These tools serve to assist our recruitment team but do not override human judgment. All final hiring decisions are ultimately made by humans. For further information regarding how your data is processed, please do not hesitate to contact us.

Key skills/competency

• Medical Necessity Review
• Genetic Testing
• Clinical Documentation
• Telehealth
• Regulatory Compliance
• HIPAA
• Asynchronous Workflow
• Payer Requirements
• Board Certification
• Primary Care Medicine