Managed Care Case Manager

This is a fully remote position, open to applicants in Philippines.

📋 Description

• Oversee pre-admission processes and prior authorizations with managed care organizations (MCOs), Medicare Advantage plans, and private insurers.

• Perform concurrent reviews and clinical chart audits to facilitate the extension of patient stays.

• Monitor authorizations, lengths of stay, and expiration dates to avert coverage interruptions and revenue loss.

• Liaise with insurance case managers, medical directors, and clinical teams within the facility.

• Assist with Peer-to-Peer reviews and appeals for denied coverage requests.

• Collaborate with intake, nursing, social work, and billing departments.

• Keep precise authorization records within the electronic health record (EHR) system.

• Provide weekend and high-volume coverage while ensuring effective team transitions.

⛳️ Requirements

• 2 to 4 years of experience as an RN, LPN, USRN, or Healthcare Virtual Assistant, complemented by clinical nursing education.

• Familiarity with U.S. healthcare insurance, including Medicare Advantage, Medicaid MCOs, commercial payers, and InterQual/MCG criteria is advantageous.

• Experience using PointClickCare, MatrixCare, Availity, NaviHealth, or similar platforms.

• Excellent English communication, organizational skills, attention to detail, and time management abilities.

• Capacity to handle high-volume authorization workflows autonomously.

• Must be available to work full-time during U.S. business hours, including designated weekend shifts.

• Application and resume must be submitted in English.

🏝️ Benefits

• Comprehensive training program featuring extensive initial onboarding and continuous mentorship.

• Clear path for advancement with competitive salary increases.

• Supportive global team environment.

• Dedicated Team Lead and supervisor for guidance.

• Opportunity to work remotely from home.

• Professional interactions with native English speakers to improve language skills.