• Conduct the Utilization Review process by obtaining medical information and confirming the medical necessity of hospital admissions and/or outpatient procedures • Identify her/himself by first name, title, and organization name when a call is made to or received from a facility, provider, or patient • Perform preadmission review for medical necessity of hospitalization and surgery • Assign diary date for review of continued hospital stay • Perform review for necessity of Second Surgical Opinions • Precert physical therapy for medical necessity • Perform review of medical necessity for designated outpatient tests and durable medical equipment • Perform initial and concurrent reviews during hospital stays • Notify claims office and re-insurer • Conduct phone inquiries to hospital/physician personnel regarding patient continued stay treatment and discharge status

• Responsible for processing medical necessity reviews for appropriateness of authorization for health care services • Assisting with discharge planning activities (i.e. DME, home health services) • Care coordination for members • Monitoring the delivery of healthcare services • Complete prospective, concurrent and retrospective reviews • Identify, document, communicate, and coordinate care • Engage with medical director when additional clinical expertise is needed • Maintain knowledge of regulations governing CareSource • Identify and refer quality issues to Quality Improvement • Provide guidance to non-clinical staff • Provide guidance and support to LPN clinical staff as appropriate • Assist Team Leader with special projects or research • Perform any other job related duties as requested.

Role Description iMPROve Health is seeking an adult physical medicine & rehabilitation physician with TBI experience or additional Brain Injury board certification to serve as an independent contractor (1099) performing independent external medical reviews remotely on an ad hoc basis. As a peer reviewer, you will apply your clinical expertise to evaluate cases, specific to your specialty, medical necessity and/or standard of care, supporting efforts to enhance the overall quality and integrity of health care and your profession. Please note, this is not an employed position and our contracted fee is based on credential and specialty type. Qualifications - Medical License: Must hold an unrestricted medical license in any U.S. state. - Board Certification: Required (if applicable), through a board recognized by: - The American Board of Medical Specialties (ABMS) - The American Osteopathic Association (AOA) - Another nationally recognized board granting certification. - Clinical Experience: - Have at least five (5) years full-time equivalent experience providing direct clinical care to patients. - Have experience providing direct clinical care to patients within the past three (3) years. - Knowledgeable of the issue under review, or of the current, evidence-based clinical guidelines and novel treatments for the medical or behavioral health condition, disease, treatment, or procedure under review. - Have the clinical expertise to manage the medical or behavioral health condition or disease under review. - Must be actively engaged in direct or virtual patient care for at least 20 hours per week. Administrative work does not qualify. Requirements - Reliable Wi-Fi access. - Proficiency with Microsoft Word. - Access to a computer compatible with iMPROve Health’s IT systems. - Must complete the electronic credentialing application and receive organizational approval prior to performing a case review. - Must complete a conflict of interest attestation upon credentialing and prior to performing a case review. - Active hospital medical staff privileges may be required, as applicable. - Notify the organization in a timely manner of an adverse change in licensure or certification status, including board certification status. - Cannot have current employment or affiliation with any Veterans Affairs (VA) hospital, health care system, or medical center if applying to perform VA-related peer reviews. Benefits - Make a Difference: Use your clinical knowledge to improve the quality of care patients receive. - Professional Recognition: Join a network of highly respected experts in your specialty. - Competitive Compensation: Receive fair pay for your time and expertise. - Protect Standards of Care: Help uphold the integrity of your profession. - Work Remotely: Review cases from the convenience of your home or office.

Role Description The Clinical Reviewer is responsible for reviewing and analyzing documentation to ensure compliance with OASIS data entry for Home Health, and for documentation in support of terminal illness for Hospice. Responsibilities also include: - Communication to clinical staff on necessary corrections required to meet regulation - Reporting to management any audit activity related to review This is a professional position working under the direct supervision of the Clinical Supervisor and supports the mission and vision of MultiCare Home Health and Hospice. Work situations require clinical judgment, discretional decision making and an understanding of applicable policies and procedures. Qualifications - Bachelor's degree in Nursing, or obtained within five (5) years from the initial date of hire; RN with 15+ years of service or internal candidates hired before January 1, 2021 may be considered in satisfaction of this requirement in lieu of an education agreement - Advanced degree in Nursing (MSN, PhD, DNP, ARNP) preferred - Current Registered Nurse license in Washington State or Multistate License endorsement (MLS) - Three (3) years of current Medicare Home Health and/or Hospice experience - Experience with electronic Medical Records for Home Health and Hospice - Research and special projects experience preferred Benefits - Rooted in the local community - Partnering with patients, families and neighbors across the Pacific Northwest for more than 140 years - Competitive tuition assistance, award-winning residencies, fellowships and career development to invest in you - Generous PTO, Code Lavender and Employee Assistance Programs to help you maintain balance and feel cared in your work and life - Respect, integrity, kindness and collaboration guide how we care for patients, communities and each other - Resource Groups and outreach programs help ensure every team member feels safe, seen, heard and valued - Work and live where natural beauty, adventure and strong community connections are part of everyday life Company Description We provide a comprehensive benefits package, including competitive salary, medical, dental and retirement benefits and paid time off. As required by various pay transparency laws, we share a competitive range of compensation for candidates hired into each position. The pay scale is $109,262.40 - $194,251.20 USD. However, pay is influenced by factors specific to applicants, including but not limited to: skill set, level of experience, and certification(s) and/or education. If this position is associated with a union contract, pay will be reflective of the appropriate step on the pay scale to which the applicant’s years of experience align.