Managed Care Authorization Specialist

Championhcare; Milwaukee, Northern (WI, KY); Hybrid; USD 28,000 - 33,000; Full time

Benefits offered by this job

Competitive pay

Full-time position

Growth opportunities

Job summary

Champion Care is seeking a Managed Care Authorization Specialist to support our skilled nursing facilities with authorizations, continued stay reviews, and appeals.

This role will involve direct communication with insurance case managers and payers, reviewing clinical documentation to aid payer decisions, and preventing denials while ensuring timely coverage for residents.

Qualifications

• Experience with managed care authorizations and insurance authorizations.
• Experience with continued stay reviews and utilization review.
• Knowledge of Medicare Advantage, Medicaid managed care, and payer processes.
• Ability to review clinical documentation for payer decisions.
• Strong organizational skills and attention to detail.
• Ability to manage multiple residents and deadlines while maintaining documentation.

Responsibilities

• Manage authorizations for Medicare Advantage, Medicaid, and commercial plans.
• Complete continued stay and concurrent reviews to support ongoing coverage.
• Track admissions, re-admissions, authorization periods, and changes in condition.
• Communicate with insurance case managers and payers about approvals and coverage.
• Submit NOMNCs, ABNs, and other payer documentation.
• Assist with denial management and appeals.

Skills

Managed care authorizations

Insurance authorizations

Continued stay reviews

Case management

Utilization review

Payer communication

NOMNCs ABNs

Job description

Managed Care Authorization Specialist – Skilled Nursing (SNF)

$20–$24 per hour | Full-Time

Champion Care is seeking an experienced Managed Care Authorization Specialist to support our skilled nursing facilities with insurance authorizations, continued stay reviews, appeals, and payer communication.

If you have experience with managed care, insurance authorizations, utilization review, case coordination, or skilled nursing insurance processes, we want to hear from you.

This position plays an important role in keeping residents covered, preventing avoidable denials, and ensuring our facilities receive timely authorization for the care and services they provide.

What You’ll Do

• Manage managed care authorizations, updates, extensions, and appeals for Medicare Advantage, Medicaid managed care, and commercial insurance plans
• Complete continued stay and concurrent reviews to support ongoing coverage
• Review clinical documentation and facility updates to ensure payers receive the information needed for authorization decisions
• Track admissions, re-admissions, authorization periods, and changes in condition
• Communicate directly with insurance case managers and payer representatives regarding approvals, extensions, and coverage
• Identify authorization issues early and follow up quickly to help prevent denials and gaps in coverage
• Submit and manage NOMNCs, ABNs, and other required payer documentation
• Coordinate authorizations for therapy services, equipment, and specialized care
• Monitor payer portals and maintain accurate documentation of authorization status, reference numbers, approved days, and follow-up dates
• Assist with denial management and appeals when additional clinical information or reconsideration is needed
• Collaborate with nursing, therapy, admissions, business office, and facility leadership to resolve insurance and authorization issues
• Participate in daily and weekly workflow meetings to prioritize cases and remove barriers

What We’re Looking For

• Experience with managed care authorizations, insurance authorizations, continued stay reviews, case management, or utilization review
• Skilled nursing, long-term care, post-acute care, or healthcare experience strongly preferred
• Knowledge of Medicare Advantage, Medicaid managed care, commercial insurance, and payer authorization processes
• Familiarity with payer portals, clinical documentation, authorization extensions, and denial prevention
• Ability to manage multiple residents, deadlines, and facilities while maintaining accurate documentation
• Strong organizational skills and attention to detail
• Ability to work with a sense of urgency and follow cases through resolution
• Strong communication skills when working with clinical teams, facility leadership, insurance case managers, and payer representatives

Why Join Champion Care

• Competitive pay of $20–$24 per hour
• Full-time position within a growing multi-facility skilled nursing organization
• High-impact role directly connected to resident coverage, denial prevention, reimbursement, and facility performance
• Opportunity to work closely with clinical, operational, and managed care teams
• Structured processes and support
• Opportunity for continued professional growth within Champion Care

Champion Care is an Equal Opportunity Employer (EOE). We are committed to creating an inclusive environment for all employees and applicants and do not discriminate based on race, color, religion, sex, national origin, age, disability, genetic information, or any other protected status.

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