Managed Care Case Manager

Role Summary

Required work experience: 2-4 years

Location: 100% Remote - Open to All Applicants in the Philippines.

Responsibilities

• 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/high-volume coverage and 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 criteria such as InterQual/MCG 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 manage high-volume authorization workflows independently.
• Shift & Schedule - full-time (US business hours align), including dedicated Weekend Coverage.

Benefits

• Comprehensive Training: We provide extensive initial training and ongoing mentorship to set you up for success.
• A Clear Career Ladder: This role is just the beginning. We offer a clear promotional path with competitive salary increases as you grow with us.
• A Supportive Global Team: Even though we work from home, our team is tightly connected. You will have a dedicated Team Lead and supervisor
• A Dynamic Work Environment: You will be in constant communication with native English speakers, helping you to further enhance your language skills in a professional setting.
• Please submit your application and resume in English. Applications submitted in any other language will not be considered.

About the Company

Touch Support , a multinational Business Process Optimization company, is rapidly expanding its finance and support teams. We are seeking a motivated, detail-oriented individual in the Philippines to join our team as a Managed Care Case Manager. With over 350 employees across the US and Europe and a proven track record of successful remote onboarding, we are excited to offer this long-term opportunity to talented professionals like you.