Senior Case Management Analyst

Role Overview

• Help people navigate complex health needs with clarity, compassion, and strong clinical judgment
• Partner with members, families, and care teams to create practical care plans that improve health outcomes, reduce avoidable hospital stays, and make care easier to access and follow
• Build and lead care plans that address medical and psychosocial needs across the full care journey
• Align members, providers, and the health plan on clear goals, next steps, and measures of success
• Coach and advocate for members so they understand options, follow the plan, and feel supported
• Coordinate services and monitor progress to improve quality of care and member experience
• Identify creative, benefit-aligned solutions that reduce fragmentation and avoid unnecessary services
• Complete timely, accurate documentation and utilization review to support safe, effective care decisions
• Educate members on conditions, treatment options, and cost drivers so they can make informed choices
• Escalate quality-of-care concerns or complex clinical questions to the Medical Director when needed
• Contribute to team improvement by sharing feedback on workflows and supporting training or mentorship as assigned

Requirements

• Active Registered Nurse (RN) license in good standing (multistate preferred where applicable)
• Minimum 3 years of recent clinical experience
• Ability to communicate clearly in writing and verbally with members, families, and providers
• Strong judgment and problem-solving skills, with attention to detail and follow-through
• Comfort using care management and documentation tools (Windows and Microsoft Word included)
• Certified Case Manager (CCM) certification, or ability to obtain it within 18 months of hire.
• Preferred Case management experience in a health plan, hospital, behavioral health or care coordination setting.
• ASN or BSN or higher nursing degree.
• Experience improving workflows, participating in quality programs, or helping train new team members.
• Ability to interpret plan benefits and apply them to real member situations.

Benefits

• Health-related benefits including medical, vision, dental
• 401(k)
• Company paid life insurance
• Tuition reimbursement
• Minimum of 18 days of paid time off per year
• Paid holidays