Ambulatory Case Manager, RN at TEXASCONNECT INC – Lubbock, Texas

Open to Texas residents ONLY.

There are four open positions for this role.

The Ambulatory Case Manager, RN is responsible for providing comprehensive care coordination and case management services to members, ensuring seamless transitions of care, promoting health stabilization, and reducing avoidable hospitalizations. The Ambulatory Case Management team is responsible for High Risk Case Management, Complex Case Management (CCM), Special Needs Plan Case Management (SNP) and Care Coordination including Transitions of Care. This role requires strong knowledge of case management programs, health plan benefits, managed care principles, and community resources. Will engage with members, families, healthcare providers, and multidisciplinary teams to create and implement individualized care plans. Serves as a liaison between key stakeholders including members, providers, and health plans.

SPECIFIC SKILLS NEEDED

• Strong knowledge of case management principles, care coordination, and transition of care processes
• Understanding of managed care, including risk-based contracts, delegated health plans, and compliance requirements
• Ability to work collaboratively with multidisciplinary teams, patients, and families
• Strong communication, organizational, and problem-solving skills
• Computer literate, with ability to navigate multiple computer applications

EDUCATION/EXPERIENCE/TRAINING
Required:
• Associate degree
• Current California State RN licensure
• Minimum 2 years clinical experience

Preferred:
• Bachelor’s Degree
• Experience in case management.
• Managed Care experience
• Proficiency in Word and Excel