Remote Managed Care Case Manager — Authorizations & Reviews

Touch Support; Colombia; A distancia; COP 21.030.000 - 25.190.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Comprehensive training

Career ladder

Global team support

English-language development

Descripción de la vacante

Touch Support is seeking a Managed Care Case Manager to join a fully remote team in Colombia. You will handle pre-admission and prior authorizations, conduct concurrent reviews, and coordinate with insurers and clinical staff to ensure continuous coverage and accurate records.

The role requires 2–4 years of RN/LPN/USRN or Healthcare VA experience with clinical nursing education, excellent English, and the ability to manage high-volume workflows.

Formación

• 2–4 years of RN/LPN/USRN or Healthcare VA experience with clinical nursing education.
• Knowledge of US health insurance (Medicare Advantage, Medicaid MCOs) and criteria like InterQual/MCG is a plus.
• Experience with PointClickCare, MatrixCare, Availity, NaviHealth or similar systems.
• Strong English communication, organization, and time-management skills.
• Ability to manage high-volume authorization workflows independently.
• Shift: full-time, 5 days per week, US business hours align - 7 AM - 3 PM CDT, including weekend coverage.

Responsabilidades

• Manage pre-admission and prior authorizations with MCOs, Medicare Advantage, 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/high-volume coverage and ensure smooth team handoffs.

Conocimientos

RN/LPN/USRN

Healthcare Virtual Assistant

English proficiency

Authorization workflows

Time management

Educación

Clinical nursing education

Herramientas

PointClickCare

MatrixCare

Availity

NaviHealth

Descripción del empleo

Touch Support is seeking a Managed Care Case Manager to join a fully remote team in Colombia. You will handle pre-admission and prior authorizations, conduct concurrent reviews, and coordinate with insurers and clinical staff to ensure continuous coverage and accurate records.

The role requires 2–4 years of RN/LPN/USRN or Healthcare VA experience with clinical nursing education, excellent English, and the ability to manage high-volume workflows.