• Prior authorization review of physical and behavioral health related services • Utilization of clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program • Application of critical thinking and knowledge of clinically appropriate treatment, evidence-based care, and medical necessity criteria for appropriate utilization of services for members with disabilities and special healthcare needs • Taking provider calls related to prior authorization questions and making calls to members to inform of the coverage determination • Gathering clinical information and applying appropriate medical necessity criteria/guideline, policy, procedure, and clinical judgment, in order to render coverage determination/recommendation/discharge planning along the continuum of care • Utilization of clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members • Identification of members who may benefit from care management programs and facilitation of the referral • Identification of opportunities to promote quality effectiveness of healthcare services and benefit utilization • Sedentary work involving periods of sitting, talking, and listening • Performing other duties as assigned