Remote Clinical Case Manager: Care Coordination & Appeals

Guided-Care; United States; Remote; USD 70,000 - 90,000; Full time

Job summary

Guided-Care is seeking a Clinical Case Manager to oversee patient caseloads, coordinate insurance authorizations, and manage AR processes. You will participate in UR meetings and maintain high-quality client communication while upholding GUIDE principles.

Remote work is supported; nursing or therapy licensure is preferred along with 5+ years in healthcare. Strong organizational and collaboration skills are essential for success in a fast-paced environment.

Qualifications

• 5+ years of experience in a healthcare environment.
• Ideal candidate is a licensed nurse (RN, LPN) or licensed therapist (OT, OTA, PT, PTA, SLP).
• Skilled Nursing, LTACH, Hospital experience preferred.
• Independent and self-motivated with strong research and organizational skills.
• Thrives in a fast-paced, high-pressure environment.
• Strong time management with a proven ability to meet deadlines.
• Solid collaborative skills with team and clients.
• Ability to work remotely and autonomously.
• Demonstrate discretion, sensitivity, and ability to maintain confidentiality.
• Proficient in Microsoft Office; able to learn new programs; comfortable with Zoom/Teams.

Responsibilities

• Maintain a skilled caseload of 77 patients per day or as established by Senior Leadership.
• Ensure increased length of stay, higher reimbursement, and proper authorization coverage.
• Review AR logs and send them to clients on the first business day of the month for previous month.
• Attend UR meetings and participate in 1:1 with the Supervisor monthly.
• Remit on due date with all required forms and complete clinical packets for NRD to insurance.
• Follow up with insurance for NRD determinations within 72 business hours.
• Coordinate/submit all appeal requests to appeals team and sometimes QIO/Health plan directly.
• Review and obtain carve-outs as outlined in insurance contracts.
• Maintain Guided Care program accuracy and client caseload details.
• Respond to client emails and requests by end of business day.
• Maintain high level of customer service and professionalism; communicate respectfully.
• Collaborate with colleagues and handle additional cases during downtime.
• Uphold and practice company principles (GUIDE) in all work interactions.

Skills

Healthcare experience

Independent and self-motivated

Time management

Collaborative skills

Research and organizational skills

Remote work capability

Customer service orientation

Effective communication

Ability to meet deadlines

Education

RN/LPN license or licensed therapist license

Tools

Microsoft Office

Video conferencing (Zoom/Teams)

Job description

Guided-Care is seeking a Clinical Case Manager to oversee patient caseloads, coordinate insurance authorizations, and manage AR processes. You will participate in UR meetings and maintain high-quality client communication while upholding GUIDE principles.

Remote work is supported; nursing or therapy licensure is preferred along with 5+ years in healthcare. Strong organizational and collaboration skills are essential for success in a fast-paced environment.