01
Case management
Complex assessment and care planning, treatment-progress evaluation, transitions of care, provider coordination, barrier resolution, member advocacy, and workers’ compensation case management.
Case Management · Utilization Management · Clinical Operations
Lolita KorneagayRN, BSN, MBA
Where case management insight meets utilization management rigor.
I bring a whole-case perspective to healthcare decisions—connecting member needs, clinical evidence, care coordination, policy, and resource stewardship across the continuum.
Johns Creek, Georgia Experienced in remote, cross-functional environments
- 20+
- Years in healthcare
- 14+
- Years across case management and managed care
- 100%
- Current quality results
- ≈100%
- Inter-rater reliability
About
The complete clinical story—not just one moment in it.
My case management background allows me to see beyond a single authorization or review to the member’s full journey: needs, barriers, treatment progression, transitions, and outcomes.
For more than a decade, I managed complex cases, evaluated treatment progress, coordinated providers and services, resolved barriers, and helped people move through complicated healthcare systems. Today, as a Utilization Management Nurse Consultant, I pair that experience with payer-side expertise in medical necessity, clinical criteria, benefit requirements, level of care, and documentation review.
The result is a practical, whole-case perspective. I understand how policy, documentation, care coordination, clinical judgment, and operational workflows converge—and how decisions made in one part of the system affect everything that follows.
Core expertise
Two disciplines. One complete view of care.
I combine the member-centered focus of case management with the evidence- and policy-driven discipline of utilization management.
02
Utilization management
Acute and post-acute review, medical necessity, level-of-care decisions, prior authorization, and clear clinical rationale using InterQual, MCG, CMS, and plan-specific requirements.
03
The intersection
A whole-case lens that connects member needs, care progression, documentation, criteria, policy, benefits, and resource utilization to support clinically sound, operationally practical decisions.
04
Clinical operations & enablement
Quality review, workflow improvement, regional leadership, stakeholder communication, technology implementation, staff education, change support, and audit readiness.
The combined advantage
Better decisions begin with broader context.
Whole-case clinical judgment
Connects medical history, current clinical status, treatment progress, care barriers, member needs, and established criteria instead of viewing each decision in isolation.
Gaps identified sooner
Recognizes missing documentation, unresolved care needs, transition risks, coordination breakdowns, and workflow friction that can delay appropriate decisions or care.
Communication across the continuum
Translates complex clinical and policy information into focused next steps for Medical Directors, case managers, providers, operational partners, and other stakeholders.
Experience
Experience organized around the work
Explore the specialty areas behind my clinical perspective, then review the complete career chronology below.
01 Utilization Management Medical-necessity review, clinical rationale, benefit application, and provider collaboration.
Utilization Management Nurse Consultant
CVS Health / Aetna · Remote
Reviews complex acute and post-acute cases through a case-management-informed lens, applying clinical and benefit requirements, developing defensible rationale, collaborating with Medical Directors and providers, and identifying documentation and workflow gaps.
02 Case Management Payer, workers’ compensation, independent consulting, and regional leadership.
Case Manager Nurse
CVS Health / Aetna · Remote
Managed members with complex medical, behavioral, and social needs across Commercial and Medicare populations through assessment, care planning, transitions, authorizations, appeals, and barrier resolution.
Owner & Case Management Nurse Consultant
Korneagay & Associates · Los Angeles, California
Provided independent case management for complex workers’ compensation cases, serving as a liaison among injured workers, physicians, employers, attorneys, and insurance adjusters. Reviewed treatment progress, coordinated care, resolved barriers, and documented case outcomes.
Western Regional Manager of Case Management
Eagle One Case Management Solutions · Los Angeles, California
Led regional operations, monitored clinical documentation and performance, and translated organizational priorities into practical guidance for staff and stakeholders.
Case Management Nurse
ISYS Solutions · Los Angeles, California
Managed complex workers’ compensation cases, coordinating among injured workers, providers, employers, attorneys, and insurance adjusters. Reviewed medical records, coordinated treatment plans, addressed barriers, and monitored progress toward recovery and return to work.
03 Clinical Technology & Education Workflow adoption, clinician education, competency validation, and patient-monitoring technology.
Clinical Nurse Specialist
Philips · Remote
Delivered education and training on patient monitoring technologies, developed learning materials and competency assessments, and supported implementation, user adoption, workflow integration, and technology optimization.
04 Critical Care Foundation ICU, PACU, travel nursing, and GI experience supporting complex clinical judgment.
Critical Care Registered Nurse
Vanderbilt University Medical Center · LAC+USC Medical Center · Century City Doctor’s Hospital
Built the clinical foundation for a career in complex decision-making through ICU, PACU, travel nursing, and GI lab experience.
Complete career chronology
Roles shown in chronological order for quick reference.
- 2025—Present Utilization Management Nurse Consultant CVS Health / Aetna
- 2024—2025 Case Manager Nurse CVS Health / Aetna
- 2016—2024 Owner & Case Management Nurse Consultant Korneagay & Associates
- 2015—2016 Western Regional Manager of Case Management Eagle One Case Management Solutions
- 2011—2014 Case Management Nurse ISYS Solutions
- 2008—2011 Clinical Nurse Specialist Philips
- 2004—2008 Critical Care Registered Nurse Vanderbilt · LAC+USC · Century City Doctor’s Hospital
Education & credentials
Clinical depth. Operational judgment.
Graduate education
Master of Business Administration
University of Phoenix
Nursing education
Bachelor of Science in Nursing
Auburn University
Professional licensure
Registered Nurse
Active licensure in Georgia and California
Let’s connect
Looking for someone who understands both coordination and utilization?
I welcome conversations about case management leadership, utilization management, clinical strategy, quality, and care-management operations.