What you will do Identifies cases that qualify for complex/chronic condition case management and/or service coordination, based on, but not limited to, the evaluation of the following data: claims, hospital reports, risk stratification, utilization management, pharmacy reports, and referrals from internal health plan staff, clinic staff, hospital discharge planners, members and providers. Performs utilization management activities of selected services, including preauthorizations, inpatient admissions, continued stay reviews and retro reviews using established medical guidelines, clinical information and clinical education to determine medical appropriateness for coverage.