Clinical Case Manager (US Healthcare) - EST hours (Remote)
full-time•KwaZulu-Natal
About this role
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 (4:00 PM to 1:00 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.
What you'll do
- The Clinical Case Manager will manage end-to-end case management for US healthcare clients, including reviewing clinical documentation and processing authorizations. They will also coordinate claims with providers and ensure compliant billing outcomes.
About ISTA Personnel Solutions
Welcome to ISTA Solutions, your go-to remote staffing solutions provider. We understand the challenges businesses face when managing their workflows and finding the right people to execute their vision. That's why we exist—to be your dedicated partner in growth.
Here are some reasons why our services are a must-have for your business:
-We provide tailor-made workflow solutions that cater to your unique business requirements, helping you streamline your operations, reduce the turnaround time, and maximize efficiency.
-Our agents are skilled, experienced, and solely focused on your company. They are trained to deliver outstanding results while working closely with your team and adhering to your company's culture.
-We leverage our global resources to provide comprehensive support for your business, including technical assistance, billing services, and recruitment. This way, you can focus on growing your business while we take care of the back-end operations.
At ISTA Solutions, we believe in the power of building strong relationships with our clients. We strive to be your long-term partner in success, providing ongoing support and guidance to help you navigate through any challenges that may arise.
We understand the importance of transparency and honesty in business. That's why we pride ourselves on being open, ethical, and straightforward in all our client interactions.
Without ISTA, healthcare companies commonly face:
-Overburdened workforce
-Increased demand for productivity
-The need to reduce operational costs
-The lack of specialized expertise in-house
-Difficulty finding reliable remote staff
We know that these problems can have a big effect on the growth and success of your business, which is why we're here to offer you complete remote staffing solutions. Whether you need customer service support, technical assistance, or a team of virtual assistants, we have the expertise to help you achieve your business goals.
Ready to join ISTA Personnel Solutions?
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Frequently Asked Questions
What does a Clinical Case Manager (US Healthcare) - EST hours (Remote) do at ISTA Personnel Solutions?
As a Clinical Case Manager (US Healthcare) - EST hours (Remote) at ISTA Personnel Solutions, you will: the Clinical Case Manager will manage end-to-end case management for US healthcare clients, including reviewing clinical documentation and processing authorizations. They will also coordinate claims with providers and ensure compliant billing outcomes..
Is the Clinical Case Manager (US Healthcare) - EST hours (Remote) position at ISTA Personnel Solutions remote?
The Clinical Case Manager (US Healthcare) - EST hours (Remote) position at ISTA Personnel Solutions is based in KwaZulu-Natal, South Africa. Contact the company through Clera for specific work arrangement details.
How do I apply for the Clinical Case Manager (US Healthcare) - EST hours (Remote) position at ISTA Personnel Solutions?
You can apply for the Clinical Case Manager (US Healthcare) - EST hours (Remote) position at ISTA Personnel Solutionsdirectly through Clera. Click the "Apply Now" button above to start your application. Clera's AI-powered platform will help match your profile with this opportunity and guide you through the application process.