Accountability for relevant Key Performance Indicator's (KPI's) for Resource Management, including but not limited to obtaining information from Transitions of Care RN Case Managers, to synthesize the following: utilization rates per 100 participants per month for Urgent Care (UC), Emergency Department (ED) visits, Acute Hospital Admissions and Acute/post-acute Skilled Nursing Facility (SNF) Admissions and length of stay in hospital and SNF's. Performs prospective, initial, concurrent and retrospective reviews for medication utilization rates and costs, diagnostics/testing, referrals to specialists, durable medical equipment (DMEs), care giving hours and transportation utilization, assessing for appropriateness and medical necessity of the treatment requests using nationally recognized guidelines (InterQual or other criteria adopted by San Diego PACE).