Contract Physician – Medical Necessity Review (Genetic Testing)

Everlywell; United States; On-site; USD 2,200 - 4,500; Part time

Benefits offered by this job

Fixed payment per review

Flexible schedule

100% Remote

Professional Liability Insurance

Job summary

A telehealth practice affiliated with a leading remote-based healthcare company is seeking licensed physicians for a remote role focused on reviewing medical necessity for genetic testing. Responsibilities include evaluating clinical documentation and ensuring compliance with regulations. Ideal candidates have an active medical license, board certification in a primary care specialty, and preferably telehealth experience. This position offers fixed payment per review and the flexibility of a completely remote schedule.

Qualifications

• Active, unrestricted medical license in good standing.
• Board Certified in primary care specialty such as Internal Medicine, Family Medicine, or Pediatrics.
• Medicare enrollment required; preference for Medicaid enrollment in Kansas or Arkansas.
• 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.

Responsibilities

• Review clinical documentation completed by a Genetic Counselor.
• Assess and determine medical necessity for genetic testing.
• Ensure compliance with state regulations and payer requirements.
• Ensure compliance with state regulations, payer requirements, and internal clinical protocols.
• Maintain HIPAA compliance and documentation standards.

Skills

Clinical documentation evaluation

Medical necessity determination

Telehealth experience

Attention to detail

Asynchronous workflow

Medicaid enrollment knowledge

Education

Active medical license

Board Certified in primary care specialty

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