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.

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ISTA Solutions is home to rockstar professionals who aim to be engaged in defining and building an employee centric culture, focused on long term success, work-life balance, and life-long learnings. From the industries we support, to the functions we perform, ISTA has structured ourselves differently from other outsourcing companies; effectively setting ourselves apart from the rest of the pack. If you are looking for something new and something different, where you are engaged not only in your own success but in defining and building the culture you want to belong in, you've come to the right place.