CLINICAL CASE MANAGER (US HEALTHCARE) - EST HOURS (REMOTE)

ISTA Personnel Solutions South Africa is a global BPO partnering with a USA-based healthcare client providing services within Skilled Nursing Facilities (SNFs), post-acute care, and revenue cycle management. We are seeking a Clinical Case Manager with healthcare experience in SNFs, inpatient authorizations, clinical review, and medical billing. This remote role requires a detail-oriented professional who can manage complex healthcare cases, coordinate with US insurance providers, and ensure compliant billing and authorization outcomes. Important: ***Applicants must have healthcare experience — candidates without it will not be considered*** PLEASE NOTE: • Working Hours: This role requires you to work USA hours Mon - Fri from 9 am to 6 pm EST (3:00 PM to 00:00 AM South African time); however, these hours are subject to change depending on daylight savings. • Internet Requirements: A fixed fibre line with a minimum speed of 25 Mbps (upload & download) and the ability to support a wired Ethernet connection is mandatory. Applicants without a fixed fibre line cannot be considered. • Power Backup: A reliable power backup solution is required to manage load shedding and power outages. Applicants without a power backup cannot be considered. • Work Environment: This is a fully remote working role. • Public Holidays: You will be required to work on all South African public holidays (compensated as per BCEA). Key Responsibilities: • End-to-end case management for US healthcare clients • Review clinical documentation for medical necessity and level of care • Process inpatient and SNF authorizations • Coordinate authorizations and claims with providers, payers, and patients • Manage US healthcare claims from submission to resolution, including denials, rejections, and appeals • Liaise with Medicare, Medicaid, and commercial payers • Ensure accurate medical billing and coding (ICD-10, CPT) • Maintain compliant case notes and documentation • Collaborate with clinical, administrative, and finance teams • Ensure HIPAA (US) compliance • Utilize MS Office for reporting and tracking • Manage high volumes of emails with accuracy and professionalism Requirements: • Knowledge of ICD-10 and CPT coding • 1–3 years healthcare experience • Proven experience in: • Case or account management • SNFs or post-acute care • Inpatient authorization processing • Clinical review • Medical billing Advantageous: • Clinical background (Nursing or Allied Health) • Experience in sub-acute, SNF, hospice, or hospital environments • Exposure to US healthcare BPO operations • Strong documentation and reporting discipline • Experience with US insurance payers If you are not contacted within 14 working days, please consider your application unsuccessful.