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

• 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).

• 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

• 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

• 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