• Work intensely as a telephonic case manager with patients and their care team for fully and/or self-insured clients • Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, policies, procedures and regulatory standards while assessing benefits and/or members’ needs • Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues • Consults with supervisor and others in overcoming barriers in meeting goals and objectives • Presents cases at case conferences for multidisciplinary focus to benefit overall claim management • Using a holistic approach, consults with clinical colleagues, supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives • Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversations • Identifies and escalates member’s needs appropriately following set guidelines and protocols • Actively reach out to members to collaborate/guide their care • Perform medical necessity reviews