· 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.
· Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.
· Ability to multitask, prioritize and effectively adapt to a fast paced changing environment.
· Proficiency with computer skills which includes navigating multiple systems and keyboarding.
· Effective communication skills, both verbal and written