• Investigate and process medical necessity requests from both members and providers • Conduct and lead investigations and reviews for member and provider medical necessity appeals • Review the medical record of denied services for medical necessity • Provide a summary of case for the medical director and other partners in the health plan care team • Ensure that appeal timeframes are met and meet the standards of enterprise, state, and federal standards and requirements • Document and log case information for the appeal • Generate the written response to the member or provider • Serve as a subject matter expert for appeals and grievances • Commit to a career of life-long learning and continuous improvement of processes related to Utilization Review

• Ensure Clinical Experiences Support Curriculum Delivery (50% or more) • Build relationships with health care facilities and potential adjunct faculty. • Collaborate with Dean of Nursing, Area Dean of Nursing, or Regional Dean of Nursing to identify clinical experiences that are evidence-based; reflect contemporary practices and nationally established patient health and safety goals; and support the achievement of the end-of-program student learning outcomes. • Review written agreements for clinical practice agencies to ensure they are current, specify expectations for all parties, and ensure the protection of students. • Review evaluation findings related to clinical experiences and report them to the Dean of Nursing, Area Dean of Nursing, or Regional Dean of Nursing. • Collect, document and store all required student programmatic paperwork according to University and programmatic policies. • Assist with the clinical course scheduling as directed by Nursing Deans. • Collaborate with the campus staff to assign student clinical placement and collect required documentation. • Track and maintain all community-based activities in Sales Force as appropriate, utilizing the Clinical Tracking Tool as the primary database for clinical activities and documents of record. • Work collaboratively across program, school, and campus in order to maximize community clinical relationships for Rasmussen stakeholders. • Participate in campus, community and professional events to represent Rasmussen University to students, professional organizations, community partners, and other relevant constituencies within the communities. • Assist students with clarification of clinical attendance requirements of the program. • Maintain and monitor active, clinical partnership agreements in order to ensure sustained and non-interrupted student access to sites. • Work collaboratively with the Rasmussen legal and compliance team to ensure a going concern of contracts and agreements. • Assist Dean with data collection related to the achievement of the end-of-program student learning outcomes directly related to clinical learning experiences.