Case Management Senior Analyst - Allegiance - Work at Home

Job description

Case Management Senior Analyst (RN Case Manager) As a Case Management Senior Analyst, you will guide complex cases across the full care journey. You will connect members, providers, and plan partners to the right care at the right time—improving outcomes, reducing avoidable costs, and making the experience feel human. If you like solving tough problems with compassion and data, you’ll thrive here. Responsibilities: Lead complex case planning from intake through resolution, aligning clinical needs, benefits, and community resources to support safe, timely care. - Partner with members, families, providers, and internal teams to set clear short- and long-term goals and track progress toward better health outcomes. - Reduce fragmentation by coordinating services across settings (inpatient, rehab, outpatient, preventive) and adjusting plans as needs change. - Use utilization review and strong documentation to ensure services meet criteria, benefits are maximized, and care is both effective and cost-aware. - Coach members on their condition, treatment options, and next steps so they can make informed choices and stay engaged in their care. - Escalate quality-of-care or complex clinical q...