The Utilization Management Nurse collaborates with healthcare providers to ensure efficient use of health services through monitoring of member utilization and claims, making referrals for case management, and ensuring continuity of care coordination.

The Case Manager III provides comprehensive care management for clients, focusing on medical and mental health services. They monitor patient utilization and claims, collaborate with brokers and group contacts, and ensure adherence to HIPAA regulations while conducting case reviews and supporting ongoing treatment plans.