Daymark Health is a value-based oncology company redefining the cancer care experience for patients, providers, and health plans. Daymark’s comprehensive, personalized cancer care platform empowers patients with dedicated care navigation, symptom-focused support, behavioral health care, and social resources. Combined with evidence-based health interventions and a hybrid in-person + virtual care model, Daymark is improving the overall cancer experience for patients, providers, and health plans – and setting a new standard in cancer care. Daymark’s groundbreaking approach is led by CEO Dr. Justin Bekelman, a pioneer in transforming cancer care, alongside some of the nation’s foremost leaders in oncology and value-based care. Daymark Health is backed by Maverick Ventures, Yosemite, Oncology Ventures, Healthier Capital, Blue Venture Fund, and Healthcare Foundry. Be cautious of recruitment fraud, and always confirm that communications are coming from an official Daymark Health email. As a Per Diem Chart Reviewer at Daymark, you will be a key member of the Enrollment and Care Teams, supporting accurate program eligibility determinations for patients. You will review medical records, apply established clinical criteria, and ensure documentation supports eligibility for Daymark programs. Your role is essential in maintaining the integrity of our care delivery and supporting patients. WHAT YOU'LL DO In this role, you will conduct thorough reviews of medical records to support program eligibility determinations. On a day-to-day basis, this may include: - Chart Review: Conduct retrospective and concurrent reviews of inpatient, outpatient, and ancillary medical records to assess whether clinical documentation supports eligibility for Daymark Health's programs. - Criteria Application: Apply established clinical criteria and program-specific guidelines to evaluate medical necessity and eligibility determinations. - Clinical Documentation: Accurately abstract and document relevant clinical findings, diagnoses, procedures, and treatment history from the medical record. - Escalation & Collaboration: Identify documentation gaps or inconsistencies and escalate cases requiring physician or supervisor review as appropriate. - Compliance: Maintain strict confidentiality of all patient health information in accordance with HIPAA regulations and Daymark's policies, procedures, and documentation standards. - Quality Assurance: Participate in audits, quality reviews, and process improvement initiatives as requested, and stay current on program eligibility criteria and relevant regulatory updates. What We Are Looking For - Experience: An active, unrestricted Registered Nurse (RN) license in good standing is required. A minimum of 5 years of Oncology nursing experience required, with experience in case management strongly preferred. - Clinical Knowledge: Working knowledge of medical terminology, and clinical documentation standards. - Comfort with Technology: Proficiency with electronic health record (EHR) systems and comfort with tools such as Google Suite, Zoom, and Slack. - Analytical Skills: Strong critical thinking and attention to detail, with the ability to review and interpret complex clinical documentation independently. - Patient-Centric Approach: A deep commitment to Daymark's mission to support cancer patients with dignity & compassion. - Organizational Skills: Ability to manage multiple reviews simultaneously, meet established turnaround times, and maintain meticulous documentation. - Adaptability: Comfortable working independently in a dynamic environment with minimal supervision Additional Information This is a per diem, remote role. Availability of a minimum of 10 hours per week is required. Hours and schedule will vary based on organizational need, but typically range 10-20 hours per week. 2-3 hours of availability daily is strongly preferred over fewer, longer time periods. Compensation will range from $40 to $55 per hour, depending on a candidate's location and experience. Per diem employees are not eligible for benefits.

About MMRO Managed Medical Review Organization (MMRO) is an established, URAC-accredited Independent Review Organization (IRO) that provides objective, evidence-based medical peer reviews nationwide. We are currently seeking Board-Certified Neurology Physicians to join our network of sub-contracted Physician Reviewers. Responsibilities - Conduct comprehensive and objective medical chart reviews with honesty and integrity. - Produce determinations that are clear, concise, and well-supported by evidence. - Follow MMRO’s review templates, ensuring all required elements are complete and accurate. - Communicate findings in a professional manner using appropriate language and grammar. - Complete assigned reviews within the specified deadlines. - Respond promptly to communications from MMRO staff. - Review and comply with corporate training materials and review standards. - Be receptive to constructive feedback from MMRO’s Medical Director, Associate Medical Director, and Clinical Staff. - Contribute ideas for process improvement and quality enhancement. Qualifications - Licensure: Current, non-restricted license to practice medicine in any U.S. state or territory, specifically CALIFORNIA medical state license. - Board Certification: Maintained certification by a board recognized by the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA). - Experience: - Minimum of five (5) years full-time equivalent experience (37.5–40 hours per week) providing direct clinical care to patients. - Current clinical experience within the past three (3) years. - Location: Must be physically located within the United States or its territories while conducting reviews. Why Partner with MMRO - Flexible, remote contract opportunity. - Set your own schedule and case volume. - Collaborate with an experienced and supportive clinical and operations team. - Contribute to fair, evidence-based determinations that support quality healthcare decisions. Join MMRO’s network of expert physician reviewers and make an impact through clinical excellence and integrity.

Onco360 Pharmacy is looking for a Medical Prior Authorization Specialist for our Pharmacy located in New Hyde Park, NY. Work Hours: Monday-Friday - Daytime Hours either 8:30am- 5pm EST or 9:30am-6pm EST. This role may work remotely. **Starting salary at $25/hr** We also offer quarterly incentive bonuses. We offer a variety of benefits including: - Medical, Dental & Vision insurance - 401k with a match - Paid Time Off and Paid Holidays - Tuition Reimbursement - Paid Volunteer Day - Floating Holiday - Referral Incentive - Paid Life, and short & long-term disability insurance Medical Prior Authorization Specialist Summary: The Medical Prior Authorization Specialist will ensure patients receive medications that requires pre-authorization from insurance carriers by reviewing orders and clinical documentation received and investigate/identify authorization requirements needed to obtain medication coverage. They will ensure accurate insurance benefit documentation is made for specific IV and infused therapy orders. Medical Prior Authorization Specialist Major Responsibilities: - Manage prior authorization requests and appeals with insurance carriers as well as collaborating with physicians, pharmacists, and other departments. - Develop expertise and maintain in-depth knowledge of insurance authorization policies, coverage terms, and complex authorization and appeal process. Identify the appropriate clinical records and submit the authorization request to the insurance company based on plan requirements for approval. - Maintain accurate documentation of authorization details and proactively monitor and renew expiring authorizations. - Facilitate process for requesting medical authorizations, completing appeals for applicable commercial, Medicaid, and Medicare, or facility medication claims. - Will require reimbursement experience for oncology and/or specialty injected/infused products in a buy and bill setting across all sites of care. - Ensure HIPAA compliance while handling sensitive patient information. - Communicate succinctly and professionally both verbally and through written correspondence with Physician offices, nurses, insurance companies and patients as needed. - Exhibits a positive, courteous, respectful, and helpful attitude towards patients, team members, payers, and management. Contributes team effort by accomplishing related tasks as needed and other duties as assigned. - Knowledge of payer landscape including state, federal, private third-party reimbursement issues, methodologies, and policies for physician administered products - Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards. Education/Learning Experience - Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification - Desired: Associate degree or equivalent program from a 2-year program or technical school, Certified Pharmacy Technician (PTCB), Specialty pharmacy experience Work Experience - Required: 1+ years’ Prior Authorization experience - Desired: 3+ years Specialty Pharmacy, Medical, and/or Infusion prior authorization experience Skills/Knowledge - Required: Medicare and Medical insurance and benefit verification, medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, coordination of benefits, Understanding Medicare Parts A, B, C, and D, as well as relevant laws and guidelines, NDC medication billing, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, basic math and analytical skills, Intermediate typing/keyboarding skills. - Desired: Specialty Pharmacy experience, Medicare Billing Experience, Medical Authorization experience Licenses/Certifications - Required: None - Desired: Registration with Board of Pharmacy as required by state law or Certified Pharmacy Technician (PTCB) Behavior Competencies - Required: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers. A career with us is more than just a job. It's an opportunity to connect and care for our patients, providers, communities and each other. We attract extraordinary people who have a strong desire to live our mission - to better the lives of those battling cancer and rare diseases. Compassion is more important than numbers. We value teamwork, respect, integrity, and passion. We succeed when you do, and our company and management team work hard to foster an environment that provides you with opportunities for both professional and personal growth.

• Apply clinical skills and expertise in conjunction with established medical criteria • Maintain a thorough and comprehensive understanding of regulations, payer contracts, product lines, NELC policies & procedures • Review clinical documentation for long term government payers twice a year • Act as a liaison between internal and external customers • Determine appropriateness and effectiveness of services requested • Responsible for timely and comprehensive medical review with concise documentation • Effectively communicate coverage decisions to members, providers, and medical groups • Identify and appropriately inform Manager/Supervisor of sensitive or complex cases • Develop and maintain positive working relationships with Medical Directors, physicians, vendors • Maintain confidentiality of member and case information