Role Description Provide medical safety expertise, directly and indirectly, to Sponsors of drugs, devices, and combination products, in the post marketing period. - Undertake primary medical review of cases, including medical assessment of the case for seriousness, listedness/labeling, causality, adverse event coding and narrative review. - Update and document daily case data, case-feedback in appropriate trackers/tools to facilitate tracking and workflow management. - Assume complete responsibility for all assigned deliverables in line with expected quality, compliance, and productivity SLAs and KPIs. - Provide training and guidance to the case processing team on medical aspects of case processing, only after a tenure of 1 year. - Perform secondary medical review (QC role) and retrospective review of cases reviewed (QA role), as required for measuring quality of deliverables, identifying error trends, training needs and areas of improvement only after a tenure of greater than 1 year. - Perform aggregate medical review and signal detection/analysis activities, as required. - Enhance existing client relationships whenever possible. - Create, maintain, and assume accountability for a culture of high customer service. - Participate in process improvement activities across Company. Qualifications - Bachelor’s degree in medical science or MD or DO or equivalent degree. - Fortrea may consider relevant and equivalent experience in lieu of educational requirements. - Language Skills: Speaking: English at ILR level 3+ or higher. - Writing / Reading: English at ILR level 4+ or higher. Requirements - Working knowledge of medical sciences, diagnosis and therapeutics including drug treatments and procedures. - Knowledge and understanding of regulatory requirements for Clinical Research. - Knowledge and understanding of ICH-GCP guidelines. Benefits - Good understanding of regulatory requirements relating to Pharmacovigilance. - Up to 1 year of pharmaceutical industry experience, including pharmacovigilance (case processing, medical review) and/or clinical research. - 1 to 2 years of Clinical practice experience. Physical Demands/Work Environment - Office or home-based environment, as requested by the line manager.

• 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.