• Provide clinical expert knowledge and clinical guidance to Quality Specialists to understand the nature of complaints and possible health risks. • Provide clinical expert knowledge, clinical data insights and risk evaluation guidance to Quality Specialists to support complaint assessment, trend identification, regulatory decision-making and potential health risk evaluation within Structural Heart therapies. • Analyze and interpret aggregate complaint, clinical and post-market data for a specific product line, business unit, regulatory submissions, regulatory agency requests and management reports, including trend identification, visualization and ad hoc analytical summaries. • Provide clinical input to Product Risk Assessments (PRA), utilizing complaint data, clinical trends and predictive risk indicators where appropriate. • Support the development and use of AI-enabled tools to enhance complaint evaluation, signal detection and quality decision-making. • Review and interpret relevant imaging information in support of complaint investigations, product quality assessments and risk evaluations. • Develop data visualization tools and dashboards to support quality monitoring, trend detection and management decision-making. • Support Product Safety in development of clinically based training materials and educate complaint staff to understand the medical aspects of complaint information and associated procedures including health risks. • Provide medical/clinical guidance and final direction to complaint staff related to event interpretation, event investigation, proper coding, required regulatory reporting, and complaint closure. • May review complaint conclusions/closure statements and/or customer letters. • May provide training to complaint staff on patient anatomy and medical conditions, products and procedures, and internal policies and procedures. • Provide support in complaint data and relevant clinical information for regulatory submissions or regulatory agency requests. • Mentor, coach, and provide training for other Clinicians Quality Compliance and Quality Specialists. • Obtain and evaluate information from clinical specialists, sales staff, physicians, nurses and other hospital staff/customers, as needed to support complaint investigation and drive towards resolution. • Support Product Safety to maintain Decision Rationale Matrix to guide complaint staff and provide final direction on reporting decisions.

• Provide individual, family, and group therapy to children with severe emotional disturbance and their families. • Complete clinical assessments, develop diagnoses, and create person/family-centered treatment plans. • Maintain a minimum of 6 service hours per family per month (at least 4 must be face-to-face). • Ensure timely completion and updating of CAFAS/PECFAS and MichiCANS assessments. • Keep accurate documentation in both electronic and paper charts, including progress notes and treatment plans. • Participate in supervision and team meetings to review client progress and strategize support. • Provide 24/7 crisis intervention support on a rotating basis. • Ensure compliance with funder and agency documentation standards. • Approve and deliver only medically necessary and approved therapeutic services. • Apply trauma-informed and co-occurring disorder care practices. • Must be willing to assist individuals with trauma-related issues. • Travel throughout the designated area using a personal or agency vehicle to deliver community-based services.

• Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical necessity for services in accordance with policies, guidelines, and NCQA standards • Prepares case reviews for Medical Directors by researching the appeal, reviewing applicable criteria, and analyzing the basis for the appeal • Ensures timely review, processing, and response to appeal in accordance with State, Federal and NCQA standards • Communicates with members, providers, facilities, and other departments regarding appeals requests • Generates appropriate appeals resolution communication and reporting for the member and provider in accordance with company policies, State, Federal and NCQA standards • Works with leadership to increase the consistency, efficiency, and appropriateness of responses of all appeals requests • Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry best practices • Performs other duties as assigned • Complies with all policies and standards

• Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical necessity for services in accordance with policies, guidelines, and National Committee for Quality Assurance (NCQA) standards • Prepares case reviews for Medical Directors by researching the appeal, reviewing applicable criteria, and analyzing the basis for the appeal • Ensures timely review, processing, and response to appeal in accordance with State, Federal and NCQA standards • Communicates with members, providers, facilities, and other departments regarding appeals requests • Generates appropriate appeals resolution communication and reporting for the member and provider in accordance with company policies, State, Federal and NCQA standards • Works with leadership to increase consistency, efficiency, and appropriateness of responses of all appeals requests • Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry best practices • Performs other duties as assigned • Complies with all policies and standards