Remote Managed Care Case Manager (RN/US Healthcare)

Touch Support, Inc. & SNF Back Office; Philippines; Remote; PHP 432,000 - 518,000; Full time

Job summary

Touch Support, Inc. & SNF Back Office in the Philippines is seeking a Managed Care Case Manager for a 100% remote role.

The position requires 2–4 years as an RN, LPN, USRN, or Healthcare Virtual Assistant with clinical nursing education and knowledge of US healthcare insurance, Medicare Advantage, Medicaid MCOs, and related systems. You will manage pre-authorizations, conduct concurrent reviews, track authorizations and lengths of stay, and communicate with case managers and facility teams.

Qualifications

• 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, and criteria like 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, five days per week (US business hours align - 7 AM - 3 PM CDT), including dedicated Weekend Coverage.

Responsibilities

• 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.

Skills

RN/LPN/USRN

Healthcare VA

Tools

PointClickCare

MatrixCare

Availity

NaviHealth

Job description

Touch Support, Inc. & SNF Back Office in the Philippines is seeking a Managed Care Case Manager for a 100% remote role.

The position requires 2–4 years as an RN, LPN, USRN, or Healthcare Virtual Assistant with clinical nursing education and knowledge of US healthcare insurance, Medicare Advantage, Medicaid MCOs, and related systems. You will manage pre-authorizations, conduct concurrent reviews, track authorizations and lengths of stay, and communicate with case managers and facility teams.