Texicare

Senior RN Clinical Care Navigation & Vendor Liaison Coordinator

Hybrid in Texas · Senior

Sponsorship not specifiedDetected 12 days ago

ComplianceHIPAAPatient CareLeadershipCommunicationProblem Solving

About the role

Reporting to the Chief Clinical Officer, you will serve as the health plan's clinical point of contact for complex care coordination, care navigation, utilization management, and case management escalations.
You will leverage your clinical expertise and managed care knowledge to assess escalated situations, identify barriers to care, coordinate appropriate next steps, and facilitate resolution of complex or high-visibility member issues.

Vendor Partnership & Care Coordination Partner with outsourced utilization management and case management vendors to facilitate timely resolution of escalated member concerns and ensure appropriate care coordination activities occur.
Work with internal and external stakeholders to implement coordination of vendor processes and projects.
Reporting, Analysis & Continuous Improvement Maintain accurate documentation of escalations, interventions, communications, and outcomes in accordance with HIPAA, regulatory, and organizational requirements.

Strong understanding of managed care processes, including utilization management, care management, care transitions, provider access, appeals and grievances, and delegated service models.
Success in this role requires strong clinical judgment, exceptional communication skills, and the ability to effectively coordinate across multiple stakeholders while maintaining a member-centered focus.
The ability to assess clinical situations, identify risks and barriers to care, determine appropriate escalation pathways, and coordinate resolution across multiple stakeholders.

Excellent communication, relationship management, documentation, organization, and problem-solving skills.

About Texicare Founded in 2023 as a mission-driven health affiliate of Texas Mutual, Texicare was created by a group of seasoned healthcare professionals, and is headquartered in Austin, Texas.
Texicare is committed to changing the healthcare landscape by providing small businesses with innovative solutions that increase access to easy-to-use, more affordable, quality health care for Texans and their families.
Texicare's vision is to transform the healthcare ecosystem for the better, helping to create a healthier and happier Texas.
Our healthcare plans were designed to be used, to remove barriers to care, to truly make a difference in people's lives.
As the first person to serve in this role, you will have a unique opportunity to help define and build the health plan's clinical escalation and care navigation function.
Serve as the health plan's clinical point of contact for complex care coordination, care navigation, and member care escalations.
Manage urgent, complex or high-profile member issues involving utilization management, care management, provider access, transitions of care, benefits, and healthcare navigation.
Coordinate with internal departments including Customer Experience, Provider Relations, Compliance, Quality, Operations, and Medical Management to support effective issue resolution.
Recognize high-risk or urgent situations requiring involvement of vendor clinical teams, Medical Directors, Behavioral Health, Compliance, Quality, or executive leadership.

We're looking for passionate, mission-driven individuals to join us in creating a healthier and happier Texas.

This listing is sourced directly from Texicare's careers page and normalized into a canonical job model.