Applies motivational interviewing in identifying impact on member engagement and setting goals Member education, medication reconciliation and benefit management Ensures follow through with the Care Navigation Team; timely appointments and referrals to programs, health plan and community Facilitate patient/family and provider communications as indicated and advocate for patient/family with healthcare team as needed Ensures coordinated services delivered and available programs are accessed Communicate with stakeholders, appropriate health care related information to ensure timely coordination care and services for members currently receiving inpatient care Utilizes approved clinical criteria to asses and determine appropriate level of care for members currently receiving inpatient care Identified point of contact for managing transitions of care