Genetic Testing Physician- California

Summary

As a Genetic Testing Physician  at Gainwell, you will provide senior-level clinical expertise and oversight for genetics and genetic testing programs. This role supports medical necessity determinations, provider engagement, clinical policy development, and quality improvement initiatives related to hereditary conditions, genomic testing, pharmacogenomics, and precision medicine services. The Advisor Medical Expert serves as a trusted clinical advisor to clients, providers, and internal teams to promote high-quality, evidence-based, and cost-effective healthcare outcomes.

Your role in our mission

When joining Gainwell, you will:

• Serve as the physician subject matter expert for genetics, genomics, hereditary disorders, and genetic testing services.
• Review complex authorization requests, appeals, and medical necessity determinations related to molecular diagnostics, genomic testing, pharmacogenomics, and hereditary disease evaluations.
• Conduct peer-to-peer consultations with providers and apply evidence-based clinical criteria to support appropriate testing and treatment decisions.
• Provide clinical guidance to utilization management, quality, case management, and operational teams.
• Interpret and apply Medicaid regulations, medical policies, and national genetic testing guidelines to support program compliance.
• Collaborate with clients and internal stakeholders to improve healthcare outcomes, quality initiatives, and appropriate utilization of genetic testing services.

What we're looking for

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) with an active, unrestricted U.S. medical license.
• Active, unrestricted license to practice medicine in the State of California required.
• Board Certification in Medical Genetics and Genomics, Clinical Genetics, or a related specialty.
• Minimum of 5+ years of post-residency clinical experience in genetics, genomics, hereditary diseases, or genetic testing programs.
• Strong knowledge of molecular diagnostics, genomic testing, hereditary cancer syndromes, rare diseases, pharmacogenomics, and evidence-based clinical guidelines.
• Experience with Medicaid programs, utilization management, prior authorization, appeals, or medical review activities, with strong analytical, communication, and decision-making skills.

What you should expect in this role

• Remote position supporting Medicaid healthcare programs. Candidates must perform work while located within the United States.
• Full-time temporary assignment expected to last 9-12 months, with potential for extension based on business needs. Standard schedule: Monday-Friday, 8:00 AM-5:00 PM; flexibility required as needed.
• Collaborate closely with providers, genetic counselors, laboratories, clients, and multidisciplinary healthcare teams.
• Participate in peer-to-peer reviews, complex case consultations, and medical necessity determinations related to genetic testing and precision medicine services.
• Contribute to clinical policy development, quality outcomes, and program effectiveness through the review of clinical documentation and evidence-based decision-making.