• Liaison with local school districts. • Identify and contact schools/districts to place student teachers and other education credential candidates, in accordance with CTC requirements. • Assign University Clinical Supervisors to fieldwork students • Participate in training of University Clinical Supervisors • Follow up on evaluations of candidates and University Clinical Supervisors and district supervisors. • Conduct orientation with University Clinical Supervisors and candidates prior to commencing fieldwork. • Counsel and develop action plans for candidates who are experiencing difficulty in fieldwork. • Identify school districts needing agreements and notify the Central Office of any changes or issues.

Role Description The Appeals Coordinator gathers all information required for an appeal, writes, and submits the appeal to the insurance company, makes follow-up phone calls, and maintains documentation of all steps taken. The Appeals Coordinator uses clinical criteria guidelines and clinical documentation to develop sound and well-supported appeal arguments to support medical necessity. The Appeals Coordinator works independently and collaboratively with other departments to positively affect clinical and financial outcomes. - Display knowledge of clinical pertinence and managed care requirements to support medical necessity criteria for inpatient and outpatient levels of care. - Verify the information needed by the insurance plan for an appeal, where to submit the appeal, and method of submitting appeal. - Manage large volumes of documents including copying, faxing and scanning incoming mail. - Document and log information on tracking systems and mainframe systems. - Ensure appeals are completed thoroughly and on a timely basis. - Interface with managed care organizations, external reviews, and other payers. - Obtain access to various provider portals and utilize portals for submitting appeals and following up on status of appeals when applicable. - Communicate with facility UR staff when needed to efficiently complete the appeal process. Qualifications - Bachelor’s Degree in social work, RN or degree in a related behavioral health field. - Minimum of 2 years of experience in a managed care/healthcare setting. Requirements - Previous utilization review experience in a psychiatric healthcare facility preferred. - Computer proficiency in Microsoft Office applications and other software programs essential to perform job functions. - May be required to work flexible hours and overtime. Benefits - Comprehensive Benefits: Multiple levels of medical, dental and vision coverage for full-time and part-time employees. - Financial Protection & PTO: Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off. - Financial & Career Growth: Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match. - Employee Well-being: Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs). - Professional Development: Ongoing learning and career advancement opportunities.

• 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

• 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