• Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. • Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus. • Utilizes clinical experience and skills in a collaborative process to assess appropriateness of treatment plans across levels of care, apply evidence based standards and practice guidelines to treatment where appropriate. • Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. • Provides triage and crisis support. • Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care facilitates including effective discharge planning. • Coordinates with providers and other parties to facilitate optimal care/treatment. • Identifies members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services and/or programs. • Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization. • Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.