• Performing care management within the scope of licensure for members with complex and chronic care needs • assessing, developing, implementing, coordinating, monitoring, and evaluating care plans • Ensures member access to services appropriate to their health needs • Conducts assessments to identify individual needs and a specific care management plan • Implements care plan by facilitating authorizations/referrals as appropriate • Coordinates internal and external resources to meet identified needs • Monitors and evaluates effectiveness of the care management plan • Modifies as necessary • Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans • Negotiates rates of reimbursement, as applicable • Assists in problem solving with providers, claims or service issues