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.