Managed Care Case Manager

🔥 16 minutes ago

🇲🇽 Mexico – Remote

💵 $665 / month

⏰ Full Time

🟢 Junior

🟡 Mid-level

👔 Manager

🚫👨‍🎓 No degree required

👻 Ghost score 3%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Touch Support, Inc. & SNF Back Office

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201 - 500 employees

Founded 2003

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

Touch Support, Inc. & SNF Back Office is a company specializing in outsourced support services and cloud strategy, focusing on enhancing customer satisfaction and building strong client relationships. The company integrates into other businesses to optimize workflows and improve customer service processes with the help of skilled personnel, business process optimization, and real-time data analysis using VisX Analytics. Their services aim to boost client workflow and customer satisfaction, providing seamless integration so clients' customers do not notice their presence. They also offer financial services expertise, optimizing bookkeeping, accounting, and billing services, contributing to smarter strategic decision-making and improving customer engagement and brand loyalty.

📋 Description

• Manage pre-admission and prior authorizations with MCOs, Medicare Advantage, and commercial insurers • Conduct concurrent reviews and clinical chart audits to support continued stays • Track authorizations, length of stay, and expiration dates to prevent coverage gaps and lost revenue • Communicate with insurance case managers, medical directors, and facility clinical teams • Support Peer-to-Peer reviews and appeals when coverage is denied • Coordinate with intake, nursing, social work, and billing teams • Maintain accurate authorization records in the EHR • Provide weekend and high-volume coverage • Ensure smooth team handoffs

🎯 Requirements

• 2–4 years of experience as an RN, LPN, USRN, or Healthcare Virtual Assistant with clinical nursing education • Knowledge of US healthcare insurance, Medicare Advantage, Medicaid MCOs, commercial payors, and InterQual/MCG criteria is a plus • Experience with PointClickCare, MatrixCare, Availity, NaviHealth, or similar systems • Strong English communication, organization, attention to detail, and time-management skills • Ability to independently manage high-volume authorization workflows • Full-time availability, five days per week, during US business hours aligned to 7 AM–3 PM CDT • Weekend coverage availability • Application and resume must be submitted in English

🏖️ Benefits

• Comprehensive initial training and ongoing mentorship • Clear promotional path with competitive salary increases • Dedicated Team Lead and supervisor • Remote work-from-home arrangement • Professional environment with opportunities to enhance English language skills

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