• Support the validation of QCAA Business Question sets • Thoroughly check and provide feedback on question sets, case studies, marking rubrics, and learning guides

Role Description We are looking for QCAA Certified Teachers to support the validation of QCAA Business Question sets. In this contract-based role, you will have the opportunity to thoroughly check and provide feedback on sample sets of questions, case studies, marking rubrics, and learning guides for QCAA Business General. This opportunity might suit you if: - You have at least 3 years experience teaching QCAA Business General at years 11 and 12. - You are experienced in peer-checking educational content and providing feedback to others. - You have strong attention to detail. - You are tech-savvy and enjoy working with technology. The project will commence in mid July. We require a commitment of approximately 4.5 hours to complete the question set review. For successful candidates, there may be an opportunity to return for further question set reviews in mid-July. Employment will be contract-based, and payment will be based on deliverable items. Qualifications - QCAA Certified Teacher. - At least 3 years experience teaching QCAA Business General at years 11 and 12. Requirements - Experience in peer-checking educational content. - Strong attention to detail. - Tech-savvy and comfortable with technology. Benefits - Opportunity for further question set reviews. - Contract-based employment. - Payment based on deliverable items.

• Perform medical necessity utilization management and care coordination activities that promote quality, cost-effective, evidence-based behavioral health care. • Review behavioral health services for medical necessity using nationally recognized clinical criteria. • Conduct pre-authorization, admission, concurrent, retrospective, and discharge reviews for inpatient and outpatient behavioral health services. • Evaluate the appropriateness of requested levels of care and treatment plans. • Collaborate with physician reviewers on cases requiring medical necessity determinations or denials. • Research and obtain additional clinical information needed to support utilization management decisions. • Assess requests for out-of-network services when appropriate. • Proactively support discharge planning to ensure seamless transitions across the continuum of care. • Partner with providers, and interdisciplinary teams to coordinate behavioral health services and transitions of care. • Facilitate referrals to community-based services and internal care management programs. • Assist with provider and member appeals related to behavioral health services. • Participate in quality improvement initiatives, clinical projects, and departmental workgroups. • Contribute to the development and revision of departmental policies and procedures. • Maintain accurate, objective, and timely documentation supporting clinical decisions.

• Analyze and review inpatient claims following the Official Coding and Reporting Guidelines to validate the reported ICD-10-CM/PCS codes to ensure proper DRG assignment for accurate billing. • Demonstrates the ability to perform a comprehensive initial review as outlined in the standard operating procedures and departmental guides. • Collaborates with physician reviewers, as needed. • Ability to prioritize and organize workload and complete tasks independently. • Required attendance of all departmental team meetings and/or training. • Work on other duties or tasks, as necessary. • Report productivity daily utilizing department productivity report. • Meet/exceed daily productivity expectations. • Maintains 95% accuracy in claim reviews. • Must be available to work a 7.5-hour workday during Eastern Standard Time (EST) business hours. • Comply with organization policy and procedures.