Clinical Case Manager: Utilization & Billing Liaison

Outcome HC; Pooler (GA); On-site; USD 70,000 - 95,000; Full time

Job summary

Outcome HC is seeking a Clinical Case Manager - Utilization Review to coordinate insurance authorizations and care planning with the interdisciplinary team. This is a detail-oriented role focusing on accurate documentation and supporting revenue cycle efficiency.

You will partner with admissions, nursing, therapy, and billing to secure timely approvals, track authorizations, and resolve denials, ensuring compliant, patient-centered care. Experience in long-term care and EMR systems is essential.

Qualifications

• Must be highly organized with the ability to manage multiple deadlines and data points.
• Proficient with EMR systems and spreadsheet tools for tracking authorizations.
• Excellent communication with insurance companies and care teams.

Responsibilities

• Insurance Authorization Management: obtain and track initial and ongoing authorizations for all plans.
• Care Team Coordination: participate in weekly meetings to align plans of care with insurance requirements.
• Billing & Financial Liaison: verify coverage and resolve denials with the billing office.
• Administrative Oversight: maintain organized electronic records and logs of communications with payers.

Skills

Systematic organization

Technical proficiency

Professional communication

Clinical knowledge (long-term care)

Education

RN or LSW with utilization review experience

Tools

EMR systems

Microsoft Excel / Google Sheets

Job description

Outcome HC is seeking a Clinical Case Manager - Utilization Review to coordinate insurance authorizations and care planning with the interdisciplinary team. This is a detail-oriented role focusing on accurate documentation and supporting revenue cycle efficiency.

You will partner with admissions, nursing, therapy, and billing to secure timely approvals, track authorizations, and resolve denials, ensuring compliant, patient-centered care. Experience in long-term care and EMR systems is essential.