Remote Managed Care Case Manager (RN/LPN)

Touch Support; Medellín; Presencial; COP 19.583.000 - 26.515.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Comprehensive training

Career ladder and growth

Global remote team support

Dedicated Team Lead

Descripción de la vacante

Touch Support, a multinational company, is hiring a Managed Care Case Manager in Colombia for a fully remote role. You will manage pre-auths with MCOs, conduct reviews, and coordinate with healthcare teams to ensure continuous coverage while aligning with US business hours.

The ideal candidate has 2–4 years of nursing or healthcare VA experience, strong English communication, and familiarity with systems like PointClickCare or MatrixCare.

Formación

• 2–4 years of experience as an RN, LPN, USRN, or Healthcare Virtual Assistant with clinical nursing education.
• Knowledge of US healthcare insurance, Medicare Advantage, Medicaid MCOs, commercial payors, and criteria such as InterQual/MCG is a plus.
• Experience with healthcare systems (PointClickCare, MatrixCare, Availity, NaviHealth) is desirable.
• Strong English communication, organization, attention to detail, and time-management skills.

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

US healthcare insurance

Strong English communication

Organization & time management

Educación

Nursing degree

Herramientas

PointClickCare

MatrixCare

Availity

NaviHealth

Descripción del empleo

Touch Support, a multinational company, is hiring a Managed Care Case Manager in Colombia for a fully remote role. You will manage pre-auths with MCOs, conduct reviews, and coordinate with healthcare teams to ensure continuous coverage while aligning with US business hours.

The ideal candidate has 2–4 years of nursing or healthcare VA experience, strong English communication, and familiarity with systems like PointClickCare or MatrixCare.