Remote Managed Care Case Manager (RN/Healthcare VA)

Touch Support; Manila; Vor Ort; PHP 457.000 - 549.000; Vollzeit

Benefits dieser Stelle

Comprehensive training

Clear career ladder

Dedicated Team Lead

Remote work from home

Zusammenfassung

Touch Support is hiring a Managed Care Case Manager to join our remote Philippines team. The role requires 2–4 years of RN/LPN/USRN or Healthcare VA experience with clinical nursing education, and familiarity with US health insurance programs.

You will handle pre-admission authorizations, concurrent reviews, and coordination across care teams from a home-based setup. We offer extensive training, a clear career ladder, and strong team support with a dedicated Team Lead.

Qualifikationen

• RN/LPN/USRN or Healthcare VA with clinical nursing education.
• Knowledge of US health insurance including Medicare Advantage/Medicaid MCOs and payors.
• Experience with care coordination systems like PointClickCare, MatrixCare, Availity, NaviHealth.
• Strong English communication, organization, and time-management skills.
• Ability to manage high-volume authorization workflows independently.
• Full-time role aligned with US business hours; includes weekend coverage.

Aufgaben

• Manage pre-admission and prior authorizations with MCOs and insurers.
• Conduct concurrent reviews and chart audits to support continued stays.
• Track authorizations, length of stay, and expiration dates to prevent gaps.
• Communicate with insurance case managers, medical directors, and facility 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 smooth handoffs.

Kenntnisse

Nursing experience

Healthcare VA

US health insurance

English communication

Authorization workflows

Ausbildung

Nursing degree or equivalent

Tools

PointClickCare

MatrixCare

Availity

NaviHealth

Jobbeschreibung

Touch Support is hiring a Managed Care Case Manager to join our remote Philippines team. The role requires 2–4 years of RN/LPN/USRN or Healthcare VA experience with clinical nursing education, and familiarity with US health insurance programs.

You will handle pre-admission authorizations, concurrent reviews, and coordination across care teams from a home-based setup. We offer extensive training, a clear career ladder, and strong team support with a dedicated Team Lead.