Case Management Senior Analyst in United States at Jobgether

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Case Management Senior Analyst in United States.

This role offers an opportunity to make a meaningful impact by supporting individuals through complex healthcare journeys with compassion, clinical expertise, and strategic care coordination. As part of a collaborative and patient-focused environment, you will work closely with members, healthcare providers, and interdisciplinary teams to improve outcomes and ensure timely access to appropriate care. The position combines clinical judgment, utilization management, and advocacy to help reduce care fragmentation while enhancing the overall member experience. Ideal for professionals who thrive in dynamic healthcare settings, this role also provides opportunities to contribute to quality initiatives, mentor peers, and influence care delivery practices. With a strong emphasis on collaboration, continuous improvement, and member-centered care, this is an excellent opportunity for experienced nurses seeking both purpose and professional growth in a remote-friendly environment.

• Lead complex case management activities from intake through resolution, coordinating care plans that align clinical needs, benefit structures, and community resources.
• Collaborate with members, families, healthcare providers, and internal stakeholders to establish measurable health goals and ensure continuity of care across inpatient, outpatient, rehabilitation, and preventive services.
• Conduct utilization reviews and maintain accurate documentation to support cost-effective, evidence-based care and appropriate service authorization.
• Educate and guide members regarding diagnoses, treatment options, care pathways, and available resources to encourage informed healthcare decisions and engagement.
• Escalate complex clinical concerns and quality-of-care issues when necessary while supporting timely decision-making processes.
• Participate in quality assurance initiatives, risk discussions, onboarding activities, and mentorship efforts to strengthen team performance and operational excellence.

• Active RN license with compact licensure eligibility and an Associate Degree in Nursing (ASN) or higher.
• Minimum of 3 years of recent clinical nursing experience with strong knowledge of care coordination and patient advocacy.
• Experience managing complex healthcare cases across multiple care settings and collaborating with interdisciplinary teams.
• Strong communication and interpersonal skills with the ability to engage effectively with members, families, providers, and business partners.
• Comfortable working with digital systems and healthcare technology platforms, including Microsoft Office tools and evolving case management systems.
• Previous experience in case management, health plans, or utilization management environments is highly valued.
• Certified Case Manager (CCM) credential or willingness to obtain certification within 12 months of hire is preferred.
• Experience with quality improvement initiatives, mentoring, or training activities is considered an asset.
• Reliable home internet connection meeting minimum speed requirements for remote work capability.

• Competitive annual salary ranging from $57,600 to $96,000 USD based on experience and location.
• Eligibility for annual performance-based bonus programs.
• Comprehensive medical, dental, and vision coverage starting on day one.
• Access to behavioral health and wellness support programs.
• 401(k) retirement plan with company contributions.
• Company-paid life insurance coverage.
• Tuition reimbursement opportunities for continued professional development.
• Generous paid time off package including paid holidays and a minimum of 18 PTO days annually.
• Fully remote or hybrid flexibility depending on business needs.