• Assesses patient's clinical need against established guidelines and/or standards to ensure that the level of care and length of stay of the patient are medically appropriate for inpatient stay. • Evaluates the necessity, appropriateness and efficiency of medical services and procedures provided. • Coordinates and assists in implementation of plan for members. • Monitors and coordinates services rendered outside of the network, as well as outside the local area, and negotiate fees for such services as appropriate. • Coordinates with patient, family, physician, hospital and other external customers with respect to the appropriateness of care from diagnosis to outcome. • Monitors patient's medical care activities, regardless of the site of service, and outcomes for appropriateness and effectiveness. • Advocates for the member/family among various sites to coordinate resource utilization and evaluation of services provided. • Encourages member participation and compliance in the case/disease management program efforts. • Documents accurately and comprehensively based on the standards of practice and current organization policies. • Interacts and communicates with multidisciplinary teams either telephonically and/or in person striving for continuity and efficiency as the member is managed along the continuum of care.