• 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 • Assesses appropriateness of treatment plans across levels of care • Applies evidence-based standards and practice guidelines to treatment where appropriate • Coordinates, monitors and evaluates options to facilitate appropriate healthcare services/benefits for members • Provides triage and crisis support • Gathers clinical information and applies the appropriate clinical criteria • Coordinates with providers and other parties to facilitate optimal care/treatment • Identifies members at risk for poor outcomes and facilitates referral opportunities