Clinical Case Manager (US Healthcare) - EST hours

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:

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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.

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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.

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Power Backup: A reliable power backup solution is required to manage load shedding and power outages. Applicants without a power backup cannot be considered.

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Work Environment: This is a fully remote working role.

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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.

Originally posted on Himalayas