# Clinical Case Manager (US Healthcare) - EST hours (Remote)

**Company:** [ISTA Personnel Solutions](http://jobs.workable.com/companies/iSt64sfgHWn4ef4KKpqeK9.md)
**Location:** Remote
**Workplace:** remote
**Employment type:** Full-time
**Department:** South Africa

[Apply for this job](http://jobs.workable.com/view/2e20a1cb-5f61-493a-a3e9-d44c73758a6a)

## Description

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.**_