Nurse Case Manager & Prior Authorization Liaison

PARADIGM HEALTHCARE; Houston (TX); On-site; USD 70,000 - 95,000; Full time

Job summary

Paradigm Healthcare LLC is seeking a Licensed Nurse Case Manager to provide telephonic case management, insurance verification, and prior authorization for our skilled nursing facilities. You will coordinate with managed care organizations, referral sources, and facility leadership to promote appropriate levels of care and optimize reimbursement opportunities.

The role requires an active RN license, 2+ years in SNF case management, and proficiency with PointClickCare and payer portals.

Qualifications

• Active RN license.
• 2+ years in SNF case management or managed care verification.
• Experience with PointClickCare in a SNF setting.
• Proficient in Outlook, Office Suite, Teams, and payer portals.
• Recent skilled long‑term care experience preferred.
• Ability to work independently in a fast-paced environment.

Responsibilities

• Provide telephonic case management to assigned SNFs.
• Review benefits verification and authorization data for appropriate level of care.
• Notify MCOs of admissions and initiate clinical assessments.
• Conduct initial, concurrent, and continued stay reviews for coverage.
• Manage NOMNC processes and track appeals with facility teams.
• Coordinate referrals, authorizations, and physician assignments.
• Support billing and revenue cycle with authorization clarification.

Skills

Nurse License

Case management

Communication

Independent decision making

Payer/authorization

Microsoft Outlook/Office

PointClickCare

Tools

PointClickCare

Payer portals

Job description

Paradigm Healthcare LLC is seeking a Licensed Nurse Case Manager to provide telephonic case management, insurance verification, and prior authorization for our skilled nursing facilities. You will coordinate with managed care organizations, referral sources, and facility leadership to promote appropriate levels of care and optimize reimbursement opportunities.

The role requires an active RN license, 2+ years in SNF case management, and proficiency with PointClickCare and payer portals.