• Provides active care management, assesses service needs, develops and coordinates action plans in cooperation with members, monitors services and implements plans, to include member goals. • Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions. • Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits. • Provides telephonic support for members with chronic conditions, high-risk pregnancy or other at-risk conditions that consist of: intensive assessment/evaluation of condition, at-risk education based on members’ identified needs, provides member-centered coaching utilizing motivational interviewing techniques in combination with reflective listening and readiness to change assessment to elicit behavior change and increase member program engagement. • Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans. • May identify, initiate, and participate in on-site reviews. • Serves as member advocate through continued communication and education. • Promotes enrollment in care management programs and/or health and disease management programs. • Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members. • Performs medical or behavioral review/authorization process. Ensures coverage for appropriate services within benefit and medical necessity guidelines. • Utilizes allocated resources to back up review determinations. • Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of care Referrals, etc.). • Participates in data collection/input into system for clinical information flow and proper claims adjudication. • Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies, which may include but is not limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal). • Maintains current knowledge of contracts and network status of all service providers and applies appropriately. • Assists with claims information, discussion, and/or resolution and refers to appropriate internal support areas to ensure proper processing of authorized or unauthorized services.

• Provides active care management, assesses service needs, develops and coordinates action plans in cooperation with members • Monitors services and implements plans, to include member goals • Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions • Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits • Provides telephonic support for members with chronic conditions, high-risk pregnancy or other at-risk conditions • Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans • Promotes enrollment in care management programs and/or health and disease management programs • Provides appropriate communications regarding requested services to both health care providers and members • Performs medical or behavioral review/authorization process • Ensures coverage for appropriate services within benefit and medical necessity guidelines • Utilizes allocated resources to back up review determinations • Identifies and makes referrals to appropriate staff • Participates in data collection/input into system for clinical information flow and proper claims adjudication • Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies • Maintains current knowledge of contracts and network status of all service providers

• Conduct LMIC market and landscape research to assess opportunities, challenges, and competitive positioning. • Analyze data on healthcare markets, delivery models, and financing mechanisms to generate actionable insights. • Support the development of value propositions, market access strategies, and launch plans tailored to LMIC contexts. • Synthesize findings into clear outputs (reports, memos, slide decks) that inform partner decision-making. • Contribute to the preparation of high-quality partner deliverables, including presentations, reports, and briefing documents. • Support meetings, workshops, and strategy sessions by preparing materials and capturing key insights. • Track stakeholder perspectives and emerging developments in the global health ecosystem relevant to partner work. • Represent the team professionally in partner interactions, contributing to clear and solutions-oriented communications. • Collaborate closely with colleagues at all levels to deliver high-quality work on time. • Take ownership of assigned work packages and proactively communicate progress, challenges, and solutions. • Build knowledge of LMIC healthcare systems, access challenges, and relevant global health domains. • Contribute to internal initiatives that strengthen the Advisory practice, including frameworks, trackers, templates, and rituals.

• Assist in training various specialty skilled and/or semi-skilled courses within the Water Program. • Utilize knowledge of adult learning theories and learning styles to help maximize learner success and ensure overall effectiveness of the course instruction. • Perform online and/or classroom instruction, field-based skills training, and/or may provide technical assistance in a specialty area. • Use a variety of media to present course material. • May assist in creating new and/or updating curriculum content, when necessary, to meet learner needs. • Expected to maintain technical competence and skills. • Reports to the Agency Training Manager.