Clinical Case Manager – US Healthcare

Role Overview

• 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