• Utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program • Review services to assure medical necessity and apply clinical expertise to assure appropriate benefit utilization • Facilitate safe and efficient discharge planning • Work closely with facilities and providers to meet the complex needs of the member • Gather clinical information and apply appropriate clinical criteria/guideline to render coverage determination/recommendation • Communicate with providers and other parties to facilitate care/treatment • Identify members for referral opportunities to integrate with other products and services • Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function