• Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence-based care, and clinical practice guidelines for Behavioral Health, specific to ABA • Utilizes clinical experience and skills in a collaborative process to assess appropriateness of treatment plans across levels of care, applying evidence-based standards and practice guidelines to treatment where appropriate • Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members • Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage • 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