The RN Case Manager works collaboratively with members, healthcare providers, Utilization Review (UR) Nurses, Care Navigators, Pharmacy Benefit Managers (PBMs), and other healthcare partners to improve health outcomes, reduce avoidable healthcare utilization, and support members in navigating the healthcare system. This position focuses on identifying high-risk and high-cost members, assessing clinical and psychosocial needs, developing individualized care plans, coordinating healthcare services, and promoting appropriate, cost-effective care.