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The RN Case Manager assists members in managing acute or chronic conditions by developing collaborative care plans and providing health coaching. They facilitate access to care, coordinate services across the health continuum, and monitor progress to improve health outcomes and reduce costs.

Responsible for Medicare pricing, risk revenue analytics, and financial reporting across various segments. The role involves managing direct reports and participating in an actuarial rotation program to gain cross-functional experience.

Acts as a subject matter expert to resolve high-level escalated member and provider complaints. Provides guidance and mentoring to service advocates and assists supervisors with daily departmental activities.

Provide comprehensive legal counsel on healthcare regulatory matters and serve as a primary advisor to business units on federal and state requirements. Monitor regulatory trends, conduct risk assessments, and develop compliance policies to mitigate organizational risk.

The RN Case Manager creates and monitors treatment plans to help members meet healthcare goals while ensuring cost-effectiveness. Responsibilities include assessing health status, coordinating with providers, and reviewing medical records for necessity.