• Build and maintain Leap's outcomes framework across adherence, safety, patient-reported outcomes, and disease-specific clinical measures. • Define metric definitions, denominator and numerator logic, inclusion criteria, calculation methods, and validity standards. • Align outcomes methodologies with recognized specialty pharmacy, home infusion, and quality measurement standards where appropriate (e.g., NHIA quality measures and other industry benchmarks). • Maintain clear documentation of metric definitions, methodology updates, and the rationale for changes over time. • Define and stand up Leap's safety event taxonomy and reporting approach across infusion reactions, treatment interruptions, escalation events, near-misses, and other clinically relevant incidents. • Own the clinical review and quality assurance process supporting accurate safety event capture from clinical documentation and operational workflows. • Produce recurring safety trend reports for clinical leadership, including root-cause themes, emerging risks, and recommendations for process improvement. • Build patient-level adherence monitoring across therapies, conditions, and populations. • Define infusion-specific adherence methodology — persistence, schedule conformance, dose fidelity, treatment completion, and tolerability — rather than retail-pharmacy measures like PDC or MPR, which weren't built for HCP-administered infusion therapy. • Build a risk-flagging process that identifies patients at elevated risk for treatment interruption or discontinuation, incorporating signals such as missed infusions, delayed authorizations, site-of-care disruptions, and medication access barriers. • Partner with care teams to operationalize proactive outreach triggers for at-risk patients. • Select, adapt, and implement validated patient-reported outcome instruments appropriate for specialty infusion populations where clinically appropriate. • Partner with Engineering and Clinical Operations to implement survey delivery workflows and structured response capture. • Analyze and interpret outcomes data to generate clinically defensible evidence of program impact. • Produce outcomes reporting and evidence packages supporting employer reporting, client QBRs, payer discussions, and manufacturer partnerships.

Role Description Fairview has an exciting opportunity for a RN Clinic Specialist to join our Endoscopy Support team. This role is a Casual position on the day shift and is 100% remote, offering the flexibility to work from home while staying connected to a collaborative clinical team. This position typically works shifts starting between 7:00 a.m. and 8:00 a.m., with end times between 5:00 p.m. and 6:00 p.m. Flexibility to provide lunch-time coverage as required is expected. We’re proud to support a healthy work–life balance, with a predictable daytime schedule, reduced FTE for added flexibility, and a remote work environment designed to help you thrive both professionally and personally. This position is ideal for an experienced nurse who values meaningful work, team connection, and the ability to maintain balance outside of work. This specialized Registered Nurse performs both independent nursing and delegated medical functions: - Independent nursing includes assessment, planning, delivery, and evaluation of nursing care for assigned patient population(s) usually in specialty or acute care clinics. - Delegated medical function includes participation in and coordination of delegated patient care to other health care team members. - Responsible for performing these functions in accordance with all policy, procedure, and professional practice guidelines. - Assists provider with complex procedures and independently completes a variety of tasks including, but not limited to: - Injections - Phone triage - Preparation of education materials - Patient education - Patient vital checks - Chart documentation - Monitors standards of care - Keeps up to date on technological advances and new pharmaceutical products. Qualifications - Associates Degree in Nursing or Bachelor of Science Nursing - Specialty training or graduate classes related to clinical area of practice - 5 years of hospital or clinic experience or 2 years of specialty/critical care experience with specialty certification - Basic Life Support (American Heart Assoc or Red Cross) Benefits - Generous benefit package including but not limited to: - Medical, dental, vision plans - Life insurance - Short-term and long-term disability insurance - PTO and Sick and Safe Time - Tuition reimbursement - Retirement - Early access to earned wages - And more! Compensation Disclaimer An individual's pay rate within the posted range may be determined by various factors, including skills, knowledge, relevant education, experience, and market conditions. Additionally, our organization prioritizes pay equity and considers internal team equity when making any offer. Hiring at the maximum of the range is not typical. If your role is eligible for a sign-on bonus, the bonus program that is approved and in place at the time of offer, is what will be honored. EEO Statement EEO/Vet/Disabled: All qualified applicants will receive consideration without regard to any lawfully protected status.

• Generate comprehensive first-level, second-level, and escalated appeal letters for denied claims. • Develop compelling clinical arguments using medical records, physician documentation, industry standards, and payer policies. • Create appeal packages with all required supporting documentation and submit within payer timelines. • Track appeal status, deadlines, and outcomes to ensure timely follow-up. • Review and revise appeal content to improve quality, consistency, and overturn success rates. • Review and assess denials related to: • Medical necessity • Level of care • Clinical validation • Authorization issues • Audit findings • Conduct detailed chart reviews to validate payer rationale and determine appeal viability. • Analyze denial trends and identify opportunities for overturn and prevention. • Apply CMS regulations, Medicare guidelines, LCDs, NCDs, payer policies, and industry guidance to support appeal arguments. • Maintain current knowledge of ICD-10-CM/PCS coding requirements, DRG methodologies, and reimbursement regulations. • Monitor payer updates and regulatory changes impacting denials and appeals. • Assist in developing appeal templates, reference materials, and best practices. • Provide recommendations to improve appeal effectiveness and reduce future denials. • Contribute to denial prevention initiatives through trend analysis and education. • Partner with physicians, CDI specialists, case management, utilization review, coding, and HIM teams to strengthen appeal outcomes.

Title: Clinical Appeals Specialist Location: Medford United States Job Description: Additional Position Details: FTE: 1.000000 | Full Time | Primarily Mon - Fri / 8AM - 5PM Starting Wage: $36.79-$50.59 per hour, depending on experience PLEASE NOTE: This is a remote position. Candidates will be required to have reliable broadband internet and personal cell phone service. Remote work may include working day-to-day operations during Pacific Standard business hours or online training. Candidates must live within the United States, and due to our pay practices, we are not able to employ candidates living in some states. Position Summary The Clinical Appeals Specialist is responsible for managing clinical denials by conducting a comprehensive review of clinical documentation and formulating a timely and defensible written response based on clinical documentation, evidence based medical necessity criteria, physician documentation and medical policies of the payor. Communicates identified denial trends and patterns to the Manager of Patient Accounting, the Director of Revenue Cycle and all applicable patient accounting leaders. Works to review, evaluate and improve the enterprise clinical denial and appeal process. At the direction of the Manager of Patient Accounting, this individual will orchestrate education and other performance improvement initiatives to impact clinical quality, improve efficiency and mitigate lost revenue related to medical necessity denials. Position Qualifications Experience - 3 years of clinical RN experience, including 1 year of Denial Management or Case Management or related experience and 1 year of current experience with reimbursement methodologies is required - Experience preparing appeals for clinical denials- preferred. Education - Bachelor's degree in Nursing or allied health field or equivalent- preferred Certification/Licensure - Registered Nurse Licensed by the Oregon State Board of Nursing is required - Certified Clinical Documentation Integrity Specialist (CCDS) by ACDIS- preferred - CCM: Certified Case Manager- preferred Total Rewards We offer a comprehensive Total Rewards package designed to support your well-being and professional growth, including: - Competitive Pay: Hourly and salaried positions earn market-based compensation. - Health & Wellness: Medical, dental, and vision coverage for part-time and above employees and their eligible dependents beginning within 30 days of hire. - Retirement Savings: Employer-sponsored retirement plan with company contribution and match. - Paid Time Off: Generous ETO for part-time and above employees. - Professional Development: Continue to enhance your education through our tuition reimbursement and tuition repayment program - Additional Benefits: Life insurance, disability coverage, and employee assistance programs. At Asante, we are guided by our values: Excellence - Respect - Honesty - Service - Teamwork