SNF Managed Care Authorization Pro

CHAMPION CARE; Milwaukee (WI); On-site; USD 42,000 - 50,000; Full time

Benefits offered by this job

Competitive pay

Full-time position

EOE

Job summary

Champion Care is seeking a Managed Care Authorization Specialist to support our skilled nursing facilities with insurance authorizations, continued stay reviews, appeals, and payer communication. This full-time role ensures residents remain covered and that facilities receive timely authorization for care.

You will work with nursing, therapy, admissions, and leadership to resolve authorization issues, prevent denials, and coordinate with payers on approvals and extensions.

Qualifications

• 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.

Responsibilities

• Manage managed care authorizations, updates, extensions, and appeals for Medicare Advantage, Medicaid managed care, and commercial plans.
• Complete continued stay and concurrent reviews to support ongoing coverage.
• Review clinical documentation and facility updates to ensure payers receive information needed for authorization decisions.
• Track admissions, readmissions, authorization periods, and changes in condition.
• Communicate with insurance case managers and payer representatives regarding approvals, extensions, and coverage.
• Identify authorization issues early and follow up quickly to 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.

Skills

Managed care authorizations

Insurance authorizations

Continued stay reviews

Case management

Utilization review

Skilled nursing care

Tools

Payer portals

Medical documentation systems

Job description

Champion Care is seeking a Managed Care Authorization Specialist to support our skilled nursing facilities with insurance authorizations, continued stay reviews, appeals, and payer communication. This full-time role ensures residents remain covered and that facilities receive timely authorization for care.

You will work with nursing, therapy, admissions, and leadership to resolve authorization issues, prevent denials, and coordinate with payers on approvals and extensions.