Role Description BAYADA Home Health Care has an immediate opening for a Full Time, Quality Reviewer with OASIS certification to work remotely. RN’s with certifications will be considered for this role. The Quality Reviewer is responsible for auditing, validating, and optimizing the patient’s Plan of Care (Form CMS-485) and OASIS assessments. This role ensures clinical accuracy, regulatory compliance with Medicare/CMS guidelines, and appropriate reimbursement for home health services. Responsibilities - Compare the CMS-485 against referral documents, History & Physical (H&P), OASIS, and therapy/nursing evaluations for 100% consistency and medical necessity. - Review and communicate OASIS edit recommendations to each clinician to promote OASIS accuracy. - Provide support and communication to all disciplines within the service. - Provide customer service/education and act as a resource to Medicare Certified Offices with regards to CMS guidelines, PDGM guidelines and billing related issues. - Provide ongoing communication with service offices via e-mail, zoom, or telephone (specific to the service office needs). - Communication with service offices monthly and as appropriate with a focus on documentation trends, star ratings and potential revenue impact. - Perform related duties, or as required or requested by Manager/Director. Qualifications - Competency in PC skills required to perform job function. - Active Compact RN Nursing License, with a minimum of 2 years clinical experience. - COS-C or HCS-O or COQS OASIS Certification and experience required. - HCHB experience, a plus! Requirements - Please note- Candidates must have COS-C, HCS-O or COQS in order to be considered, there is no flexibility around this requirement. Benefits - This is a fully remote position. - Base Salary: $77,000 - $80,000 / year. - BAYADA offers a comprehensive benefits plan that includes: - Paid holidays, vacation and sick leave. - Vision, dental and medical health plans. - Employer paid life insurance. - 401k with company match. - Direct deposit. - Employee assistance program.

Title: Medical Information Specialist with Greek Location: Sofia Bulgaria Full time Remote As a Medical Information Specialist I you will provides technical and medical information, and/or performs intake of adverse events/ product complaints with quality customer servce. Analyzes and researches inquiries and documents interactions according to organizational, client and regulatory guidelines. The information provided will be given to a level in parallel with the individual’s expertise, experience and training. Position Requirements • Responds accurately and professionally to technical and medical information inquiries received via phone, email, internet or mail in reference to pharmaceutical or device products. Processes fulfillments and provides clinical trial information or after-hours on call support. • Analyzes caller’s questions to formulate an accurate and concise response using client-approved resources and records inquiries and interactions in the appropriate databases following organizational, client and regulatory guidelines. • Identifies, records and triages adverse events and product complaints according to organizational, client and regulatory guidelines and provides additional support (including follow up) as needed. • Maintains thorough knowledge of project and corporate policies and procedures including client products, SOPs, protocols, GCPs, and applicable regulatory requirements. • Works closely with internal and external client contacts (up to and including members of client management) to resolve complex inquiries. As needed, researches medical literature and drafts responses for such inquiries. Education • Bachelor's degree or equivalent and relevant formal academic / vocational qualification Experience • Previous experience that provides the knowledge, skills, and abilities to perform the job (comparable to 0 to 2 years). • In some cases an equivalency, consisting of a combination of appropriate education, training and/or directly related experience, will be considered sufficient for an individual to meet the requirements of the role. Knowledge, Skills and Abilities: • Excellent verbal and written communication skills in Greek and English • Excellent language skills (comprehension, speaking, reading and writing); Fluency skills in a second language may be required • Proficient computer and keyboarding skills • Good interpersonal skills • Ability to work independently as well as part of a team. • Ability to interpret client provided complex medical and technical information • Organizational and time management skills • Ability to maintain a positive and professional demeanor in challenging circumstances

Title: Clinical Reviewer Behavioral Health Location: United States - Full-Time - Remote within the United States - Regular - 5795 Job Description: Company Overview Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector. Job Summary and Responsibilities Acentra Health is looking for a Clinical Reviewer of Behavioral Health to join our growing team. Job Summary: The purpose of this position is to review medical records against appropriate criteria in conjunction with contract requirements to determine medical appropriateness. This position is remote within the United States but will be expected to work during Eastern time zone. Responsibilities: - Assures accuracy and timeliness of all applicable review type cases within contract requirements - Assesses, evaluates, and addresses daily workload and queues; adjusts work schedules daily to meet the workload demands of the department - In collaboration with Supervisor, responsible for the quality monitoring activities including identifying areas of improvement and plan implementation of improvement areas - Maintains current knowledge base related to review processes and clinical practices related to the review processes, functions as the initial resource to nurse reviewers regarding all review process questions and/or concerns - Functions as providers' liaison and contact/resource person for provider customer service issues and problem resolution - Performs all applicable review types as workload indicates - Fosters positive and professional relationships and act as liaison with internal and external customers to ensure effective working relationships and team building to facilitate the review process - Attends training and scheduled meetings and for maintenance and use of current/updated information for review - Cross trains and perform duties of other contracts to provide a flexible workforce to meet client/customer needs - Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rule Qualifications Required qualifications: - Active and unrestricted license for the State of Virginia as a Registered Nurse (RN) OR Licensed Mental Health Professional (LMHP) such as Licensed Clinical Psychologist (LCP), Licensed Professional Counselor (LPC), Licensed Clinical Social Worker (LCSW), Licensed Substance Abuse Treatment Practitioner (LSATP), Licensed Marriage and Family Therapist (LMFT) - Associate's degree or higher from an accredited college or university in a related field - 1+ year of experience in Prior Authorization, Utilization Review, or Utilization Management - 3+ years of direct experience in a clinical setting or other applicable State clinical experience - Must be able to work weekends if needed (advance notification will be provided) Preferred qualifications: - Bachelor's degree or higher from an accredited college or university in a related field - Knowledge of the organization of medical records, medical terminology, and disease process - Strong clinical assessment and critical thinking skills - Requires excellent written and verbal communication skills - Medical record abstracting skills Why us? We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes. We do this through our people. You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career. Benefits Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more. Experience in Lieu of Degree For non-clinical roles, or when not required by the contract specifically, the Company acknowledges that practical, hands-on experience can provide skills and competencies equivalent to formal education. As such, in cases where a Bachelor's degree may be required, the Company will accept a minimum of six (6) years of directly relevant professional experience in lieu of a degree. In instances where the candidate has an Associate's degree, the Company will accept a minimum of three (3) years of directly relevant professional experience in lieu of the Bachelor's degree. Compensation The pay range for this position is listed below. "Based on our compensation philosophy, an applicant's position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level." Thank You! We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search! EEO AA M/F/Vet/Disability Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law. #LI-AF1 Pay Range USD $28.37 - USD $39.19 /Hr.

Title: Medical Reviewer I - Remote after 6 months Location: Myrtle Beach, South Carolina Job Description: Summary Join our team serving active and retired US military members and their covered family members. We strive to ensure that these dedicated individuals and their loved ones receive high-quality care administered as economically as possible and in accordance with current evidence-based care guidelines. As part of our expanding team of medical reviewers, you will evaluate the medical records to determine medical necessity and perform utilization management of professional, inpatient, outpatient facility benefits or services and appeals. You will document decisions using indicated protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices. In addition to being able to serve those who protect our country, you won’t have the physical stress of working in a direct care setting and you will have nights, weekends, and holidays off to spend with those you love. For those wanting to grow their career with us, we offer tuition reimbursement, skills training classes, an aspiring leaders’ program, and promotional opportunities throughout our family of companies. In these uncertain times, we are a solid company who has served individuals, businesses, associations, and the US government for over 70 years. Our leadership is committed to ensuring that we will be serving our customers for another 70 years. Description Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Position Purpose: Performs medical reviews using established criteria sets and/or performs utilization management of professional, inpatient or outpatient, facility benefits or services, and appeals. Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices. Logistics: PGBA - one of BlueCross BlueShield of South Carolina’s subsidiary companies. Location: This is an onsite position located at 8733 Highway 17 Bypass, Myrtle Beach, S.C., 29575. The hours are 8:00am - 5pm, Monday through Friday. This position will be remote after 6 months of training. Government Clearance: This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen. What You Will Do: - May provide any of the following in support of medical claims review and utilization review practices: Performs medical claim reviews and makes a reasonable charge payment determination. Monitors process's timeliness in accordance with contractor standards. Performs authorization process, ensuring coverage for appropriate medical services within benefit and medical necessity guidelines. Utilizes allocated resources to back up review determination. Reviews interdepartmental requests and medical information in a timely/effective manner in order to complete utilization process. May conduct/perform high dollar forecasting research and formulate overall patient health summaries with future health prognosis and projected medical costs. Performs screenings/assessments and determines risk via telephone. Reviews/determines eligibility, level of benefits, and medical necessity of services and/or reasonableness and necessity of services. Provides education to members and their families/caregivers. Reviews first level appeal and ensures utilization or claim review provides thorough documentation of each determination and basis for each. Conducts research necessary to make thorough/accurate basis for each determination made. - Educates internal/external staff regarding medical reviews, medical terminology, coverage determinations, coding procedures, etc. in accordance with contractor guidelines. Responds accurately and timely with appropriate documentation to members and providers on all rendered determinations. - Participates in quality control activities in support of the corporate and team-based objectives. Participates in all Required Licenses and Certificates. To Qualify for This Position, You Will Need: - Required Education: Bachelor's degree - Social Work, OR, Graduate of an Accredited School of Licensed Practical Nursing or Licensed Vocational Nursing. - Required Experience: 2 years clinical experience. - Required Skills and Abilities: Working knowledge of word processing software. Good judgment skills. Demonstrated customer service and organizational skills. Demonstrated proficiency in spelling, punctuation, and grammar skills. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion. Ability to remain in a stationary position and operate a computer. - Required Software and Tools: Microsoft Office. - Required Licenses and Certificates: Active, unrestricted LPN/LVN licensure from the United States and in the state of hired, OR, active compact multistate unrestricted LPN license as defined by the Nurse Licensure Compact (NLC), OR, active, unrestricted LBSW (Licensed Bachelor of Social Work) licensure from the United States and in the state of hire. ​ What We Prefer: - Preferred Education: Associate Degree- Nursing OR Graduate of an Accredited School of Nursing. - Preferred Skills and Abilities: Working knowledge of spreadsheet and database software. Demonstrated oral and written communication skills. Ability to persuade, negotiate, or influence others. - Preferred Software and Others Tools: Knowledge of Microsoft Excel, Access, or other spreadsheet/database software. - Preferred Licenses and Certificates: Active, unrestricted RN licensure from the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC). Our Comprehensive Benefits Package Includes The Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment. - Subsidized health plans, dental and vision coverage - 401k retirement savings plan with company match - Life Insurance - Paid Time Off (PTO) - On-site cafeterias and fitness centers in major locations - Education Assistance - Service Recognition - National discounts to movies, theaters, zoos, theme parks and more What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What to Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and salary requirements. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.