Value Case Management Senior Analyst - RN - Laredo, TX

Job Summary

This position is responsible for coordinating and managing relationships with participating provider practices. Maintain a detailed understanding of HEDIS/STAR performance measures. Develop and maintain a process to ensure all customers participating in provider practices meet all quality metrics. Coordinate the delivery of cost‑effective, quality‑based health care services for health plan customers by developing and implementing alternative treatment plans that address individual needs of the customer, their benefit plan, and community resources.

Plan, implement, and evaluate appropriate health care services in conjunction with the physician treatment plan. Utilize clinical skills to assess, plan, implement, coordinate, monitor and evaluate options and services to facilitate appropriate healthcare outcomes for customers.

• Current licensure as a registered nurse, in the state of residence, in good standing.
• Associate’s degree, diploma, or B.S. in Nursing.
• Three to five (3–5) years of recent experience in an acute‑care environment, case‑management, or utilization management position (experience can be a combination of LVN/RN licensure).
• Previous HEDIS and/or CMS STARs experience is a plus.

• Bilingual (English/Spanish).
• Previous HEDIS and/or CMS STARs experience.
• Strong proficiency in Microsoft Excel.
• Client‑site location:
  This is a field‑based position in the Laredo, TX market, also supporting broader Texas remotely. The individual will be onsite at provider offices 3–5 times weekly.
• Schedule:
  
  Monday – Friday, typical business hours with infrequent evening and weekend meetings.
• Sponsorship:
  Sponsorship is not available.

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

At Care Allies, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, a minimum of 15 days’ of paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for full‑time employees.

The salary offered will vary depending on your job‑related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and conditions of the plan.

$63,300.00 – $