Remote Managed Care Case Manager

Touch Support; Región Centro; Presencial; MXN 126.000 - 151.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Starting salary: $665–$800 USD gross/月

Comprehensive training

Career ladder with increases

Global team support

English-language work environment

Descripción de la vacante

Touch Support is hiring a Managed Care Case Manager to join our remote team in Mexico. The ideal candidate has 2–4 years of RN/LPN/USRN or Healthcare Virtual Assistant experience with nursing education and understands US health insurance, Medicare Advantage, and MCOs.

You will manage pre-authorizations, conduct reviews, track eligibility, and coordinate with multiple teams. The role requires strong English, meticulous organization, and weekend coverage aligning to US business hours.

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 PointClickCare, MatrixCare, Availity, NaviHealth, or similar systems.
• Strong English communication, organization, attention to detail, and time-management skills.
• Ability to manage high-volume authorization workflows independently.
• Shift & Schedule - full-time (US business hours align - 7 AM - 3 PM CDT), including dedicated 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

Strong English communication

Time management

Attention to detail

Organization

High-volume workflow management

Educación

RN/LPN/USRN or Healthcare Virtual Assistant with clinical nursing education

Herramientas

PointClickCare

MatrixCare

Availity

NaviHealth

Descripción del empleo

Touch Support is hiring a Managed Care Case Manager to join our remote team in Mexico. The ideal candidate has 2–4 years of RN/LPN/USRN or Healthcare Virtual Assistant experience with nursing education and understands US health insurance, Medicare Advantage, and MCOs.

You will manage pre-authorizations, conduct reviews, track eligibility, and coordinate with multiple teams. The role requires strong English, meticulous organization, and weekend coverage aligning to US business hours.