Case Management Analyst

The Case Management Coordinator will utilize critical thinking and professional judgment to support the case management process, facilitating improved healthcare outcomes for members through advocacy, collaboration, coordination, support, and education. This involves evaluating member benefit plans and available programs, identifying high-risk factors, and implementing proactive interventions. The role includes coordinating and implementing wellness care plan activities, monitoring member care needs, and consulting with case managers, supervisors, Medical Directors, and other health programs to overcome barriers. Responsibilities also encompass escalating quality of care issues, negotiating services to meet member needs, and using motivational interviewing skills to promote member engagement and healthy lifestyle changes. Additionally, the Case Management Coordinator will provide coaching and information to empower members in their healthcare decision-making and utilize case management and quality management processes in compliance with regulatory guidelines and company policies.