• Delivering medical or behavioral health utilization management (UM) and coordination of care services to members • Supporting the HNE mission by developing partnerships with and providing personal and accountable service to members and providers • Managing all requirements around coding review for the department • Ensuring that HNE operates within the policies, procedures, and regulations set forth by HNE and by state and federal laws • Performing pre-authorization review utilizing criteria to determine appropriateness of requested services • Assisting members and providers with transition of care, referral management, care coordination, and benefit management • Developing and coordinating general compliance educational activities as directed by the Compliance Department