Case Management Senior Analyst - Allegiance - Work at Home
Core
Guide complex cases across the full care journey by connecting members, providers, and plan partners to the right care at the right time to improve outcomes and reduce costs.
Role type
Senior Registered Nurse Case Manager
Builds
Safe, timely, and cost-effective care plans for members across inpatient, rehab, outpatient, and preventive settings
Domain
Healthcare / Health Insurance / Case Management
Required skills
Active RN license, care planning, care coordination, patient advocacy, utilization review, documentation, clinical practice in Oncology/Behavioral Health/Critical Care/Med-Surg
Preferred skills
Certified Case Manager (CCM), interpreting benefit plan documents, quality improvement, training/mentorship
Technologies
Windows, Microsoft Word
Responsibilities
Lead complex case planning from intake through resolution; Partner with members, families, providers, and internal teams to set goals and track progress; Coordinate services across different care settings; Use utilization review to ensure services meet criteria and maximize benefits; Coach members on conditions and treatment options; Escalate complex clinical questions to the Medical Director; Support quality reviews and mentor new team members