Case Management Senior Analyst - Allegiance - Work at Home

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 questions to the Medical Director and help drive timely, well-informed decisions.
• Strengthen team performance by supporting quality reviews, leading risk meetings as needed, and mentoring new team members.

Qualifications

Required

• Active RN license (state-appropriate) with an associate degree in nursing (ASN) or higher. Compact license required.
• Minimum 3 years of recent clinical practice experience.
• Strong skills in care planning, care coordination, and patient advocacy across the continuum of care.
• Clear, respectful communication (written and verbal) with members, families, providers, and business partners.
• Comfort using a PC and common tools (Windows and Word) and ability to learn new systems as they change.

Preferred

• Previous case management experience in a health plan, employer, or clinical setting.
• Certified Case Manager (CCM) credential (or ability to obtain within 12 months of hire).
• Experience interpreting benefit plan documents and applying guidelines to real member situations.
• Quality improvement or training/mentorship experience (QA programs, risk reviews, onboarding).

Originally posted on Himalayas