• Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, 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 determination/recommendation along the continuum of care • Communicates with providers and other parties to facilitate care/treatment • Identifies members for 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 • Typical office working environment with productivity and quality expectations • Work requires the ability to perform close inspection of handwritten and computer generated documents as well as a PC monitor • Sedentary work involving periods of sitting, talking, listening • Work requires sitting for extended periods, talking on the telephone and typing on the computer • Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment • Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding