• Assess the medical necessity and quality of healthcare services through utilization management reviews • Conduct prospective, concurrent, and retrospective utilization management reviews • Apply clinical review criteria, organizational policies, guidelines, and screening tools (InterQual) • Consult with physician/practitioner consultants when services do not meet medical necessity criteria • Collaborate with internal teams and refer cases for additional review or escalation as appropriate • Refer cases to management when required • Provide clinical and utilization review subject matter expertise • Respond to provider, customer, and stakeholder questions regarding determinations and processes • Conduct outreach to providers, case managers, consultants, and community support coordinators to obtain additional clinical information • Maintain accurate documentation and comply with all regulatory and contract standards

Role Description The DES, Division of Child Support Services (DCSS), is seeking an experienced and highly motivated individual to join our team as a Child Support Specialist Case Reviewer with the Administrative Review Unit (ARU). This position is responsible for providing an administrative review of child support cases as assigned pursuant to policy, procedures, federal and state rules, guidelines, and statutory requirements; providing consultative services, technical guidance, and administrative expertise to agency staff during the evaluation of contested actions on administrative enforcement remedies taken statewide. This position may offer the ability to work remotely, within Arizona, based upon the department's business needs and continual meeting of expected performance measures. The State of Arizona strives for a work culture that affords employees flexibility, autonomy, and trust. Across our many agencies, boards, and commissions, many State employees participate in the State’s Remote Work Program and are able to work remotely in their homes, in offices, and in hoteling spaces. All work, including remote work, should be performed within Arizona unless an exception is properly authorized in advance. Job Duties - Conduct a comprehensive review of child support cases when a requestor contests an administrative enforcement action taken by DCSS. - Conduct a comprehensive review of cases when a support recipient contests the distribution/disbursement of support payments as a result of the Quarterly Notice of Collections. - Adhere to strict local, state, and federal time frames in receiving, acknowledging, processing, and resolving requests for administrative reviews. - Request all related documentation needed to support or deny a request for Administrative Review. Qualifications - Strong understanding of child support arrears, past due child support, assigned support, and administrative actions. - Working knowledge of state and federal regulations, rules, and policies governing child support or family law, legal assisting, administrative, and judicial court practices. - Interviewing techniques and investigative procedures. - Computer software applications, i.e., Google Workspace and Adobe. - Assignment of rights, distribution, and disbursement of child support. Requirements - Adhere to strict state and federal timeframes. - Interpret legal or written documents, court orders, and administrative and judicial court practices. - Meet performance measures, manage time and competing priorities; follow set policies and procedures to ensure timeliness, data reliability, and accuracy. - Learn the Arizona Child Support Services automated case management system. Selective Preference(s) - Working knowledge equivalent to one (1) year of child support enforcement, child support arrears, medical, spousal, state-assigned arrears, administrative actions, and court order interpretation. Pre-Employment Requirements - Successfully pass background and reference checks; employment is contingent upon completion of the above-mentioned process and the agency’s ability to reasonably accommodate any restrictions. - Arizona Level One Fingerprint Clearance Card. - If this position requires driving or the use of a vehicle as an essential function of the job to conduct State business, then the following requirements apply: Driver’s License Requirements. - All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify). Benefits - Affordable medical, dental, life, and short-term disability insurance plans. - Participation in the Arizona State Retirement System (ASRS) and long-term disability plans. - 10 paid holidays per year. - Paid vacation and sick time. - Paid Parental Leave - Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child. - Deferred compensation plan. - Wellness plans. - Tuition Reimbursement. - Stipend Opportunities. - Infant at Work Program. - Rideshare and Public Transit Subsidy. - Career Advancement & Employee Development Opportunities.

Role Description Are you a clinically experienced Registered Nurse looking to apply your expertise beyond direct patient care? As a Medical Review Nurse you will play a critical role in strengthening risk management and improving decision-making across our health and accident products. You’ll use your clinical knowledge to evaluate medical records, guide coverage determinations, and support fair, evidence-based appeal outcomes—directly impacting both business outcomes and member experience. This is an opportunity to bring your clinical judgment, analytical thinking, and passion for quality care into a dynamic, fast-paced environment where your insights drive meaningful results. What You’ll Do - Serve as a trusted clinical expert supporting accident and health lines of business - Review medical records and claims to determine coverage and benefit eligibility - Evaluate medical necessity and appropriateness of care based on evidence-based guidelines - Draft clear, defensible written rationales for coverage and appeal determinations - Analyze medical and claims data to identify trends, risks, and improvement opportunities - Assess medical information to determine current and potential risk exposure for coverage decisions - Interpret and apply policy contract language to ensure consistent, accurate determinations - Synthesize complex data from multiple sources to inform business decisions - Maintain strong productivity and quality in a high-volume, fast-paced environment - Collaborate cross-functionally while demonstrating strong independence and accountability Qualifications - Active Registered Nurse (RN) license - Proven ability to analyze and interpret complex medical information and documentation - Strong clinical judgment and decision-making skills - Excellent written and verbal communication skills Requirements - 5+ years of clinical nursing experience - Experience in health insurance, utilization review, medical claims, or appeals - Familiarity with medical coding systems (CPT, ICD-10, HCPCS) and claims documentation - Experience interpreting insurance policy language and applying it in decision-making - Exposure to data analysis and identifying trends within medical or claims data Key Skills & Strengths - Analytical mindset with strong attention to detail - Ability to translate clinical complexity into clear, actionable insights - Strong problem-solving and critical thinking capabilities - Effective time management and ability to prioritize competing demands - Comfortable working both independently and collaboratively Tools & Expertise - Proficiency in Microsoft Office (Excel, Word, Outlook) - Experience working with medical records, physician notes, and evidence-based clinical studies - Ability to interpret Explanation of Benefits (EOBs) and submitted claims Benefits - Compensation offered for this role is $62,100.00 - $103,950.00 annually and is based on experience and qualifications. - Comprehensive technology setup, including a laptop, monitors, headset, keyboard, and mouse. - Monthly connectivity reimbursement for employees eligible to work from home.

Role Description We currently have an exciting opportunity at SGS for a Final Reviewer & Certification decision maker to join our highly successful Global Medical Device team. In this role, you will be reporting to the Final Reviewer & Certification Decision Maker Medical Device Team leader and you will have a Global role. Main Purpose of Role: - The role of the Final Reviewer & Certification decision maker is to review audit packs to verify data and their content for compliance with MDD 93/42 EC or MDR (EU) 2017/745. - Take decision on reviewed audit packs to determine if the certificate shall be issued and if there are any applicable restrictions. - Verify that audit documentation for QMS on-site as well as technical documentation assessment is in compliance with medical device regulations and internal procedures. - Ensure a good understanding of the audit trail and support the relevant evidence of compliance of the audited company. - Verify that all major non-conformity and any unsolved issues have been addressed and closed out before transferring the audit pack for certification decision. - Review whether the final review has been carried out by an approved Final Reviewer. - Ensure that the final review documentation has been completed satisfactorily. - Confirm whether all/any actions raised by the Final Reviewer have been satisfactorily addressed and closed out. - Make the final decision as to whether a certificate should be issued. - Check audit packs for QMS on-site audit for MDD / MDR / ISO13485, for technical documentation assessment and any changes. - Involve in concessions and certificate suspension when relevant. - Be in close contact with auditors, product assessors, Certificate Decision makers, and Global Medical Device Certification Manager. - Contribute in meeting operations objectives and Key Performance Indicators to deliver certificates to customers and maintain regulatory compliance. Key Accountabilities: - Establish whether the audit report pack demonstrates compliance with specific standards/normative documents. - Ensure the audit has been carried out and associated documentation completed in accordance with relevant procedures. - Verify that the auditor/audit team were confirmed as competent. - Ensure principles and practices associated with undertaking audits are applied, especially in reporting audit findings and decision-making processes. - Establish whether Final Technical Review addresses all Scope of Certification or accreditation issues relevant to specific standards/normative documents. - Ensure completion of technical review documentation and no outstanding issues remain unresolved. - Appreciate the business/industry environment in which the audit took place. - Understand and make judgment on the auditors’ interpretation and reporting of the audit findings and decision-making rationale. - Offer support and help to Certificate Decision Makers. - Ensure full compliance with the Company’s Code of Integrity & Professional Conduct. - Maintain and develop personal professional capabilities to ensure knowledge and understanding of sector expectations is up to date. - Ensure SGS operates in accordance with professional, ethical, legal and accreditation requirements to maintain all approvals. - Report data on your daily workload and any technical issues. It is remote based, and we are open to candidates located everywhere across Europe. But they must hold a valid work permit for their country of residency. Please send your CV in English! Qualifications - Experience in a similar position in a European notified body (must have). - Significant work experience in the medical device field as Lead Auditor or as Product Assessor in a Notified Body (must have). - Detailed understanding of global medical device Regulations and good analysis capacity to detect discrepancies or issues. - Good communication skills. - Strong team building skills. - Fluent in English. Other languages are a benefit. Benefits - Global and very stable company, world leader in the TIC (Testing, Inspection and Certification) industry. - Flexible schedule and hybrid model. - SGS university and Campus for continuous learning options. - Multinational environment where you will work with colleagues from multiple continents. - Benefits platform. Company Description We are SGS – the world's leading testing, inspection and certification company. We are recognized as the global benchmark for sustainability, quality and integrity. Our 99,600 employees operate a network of 2,600 offices and laboratories, working together to enable a better, safer and more interconnected world. At SGS, we have an open corporate and international culture. We offer a dynamic work environment in a leading global company. Our high professional standards and our sustainability approach guarantee you a future-oriented work environment. We invest in our employees for the long term and are committed to supporting your development within the company. Our business principles include: Integrity, Health, Safety & Environment, Quality & Professionalism, Respect, Sustainability, and Leadership.