Managed Care Case Manager
T
Touch SupportManaged care
100% Remote - Open to All Applicants in the Philippines., US business hours alignFull-TimeManager
Salary665 - 800 USD per month
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Job Details
- Languages
- Strong English communication
- Experience
- 2–4 years of experience as an RN, LPN, USRN, or Healthcare Virtual Assistant with clinical nursing education.
- Required Skills
- EHR
Requirements
- Have 2–4 years of experience as an RN, LPN, USRN, or Healthcare Virtual Assistant with clinical nursing education.
- Demonstrate strong English communication skills.
- Be organized and attentive to detail, with strong time-management skills.
- Be able to manage high-volume authorization workflows independently.
- Knowledge of US healthcare insurance, Medicare Advantage, Medicaid MCOs, commercial payors, and InterQual or MCG criteria is a plus.
- Experience with PointClickCare, MatrixCare, Availity, NaviHealth, or similar systems is preferred.
- Be available for full-time work aligned with US business hours, including dedicated weekend coverage.
Responsibilities
- Manage pre-admission and prior authorizations with MCOs, Medicare Advantage plans, and commercial insurers.
- Conduct concurrent reviews and clinical chart audits to support continued stays.
- Track authorizations, length of stay, and expiration dates to prevent coverage gaps and lost revenue.
- Communicate with insurance case managers, medical directors, and facility clinical teams.
- Support Peer-to-Peer reviews and appeals when coverage is denied.
- Coordinate with intake, nursing, social work, and billing teams.
- Maintain accurate authorization records in the EHR.
- Provide weekend and high-volume coverage and ensure smooth team handoffs.
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