Care Navigator

Maxicare; Muntinlupa; On-site; PHP 268,000 - 469,000; Full time

Job summary

Maxicare Philippines seeks a Manager to lead member support in Emergency Room coordination, ensuring only qualified emergencies access ER services and guiding LOA issuance, care redirects, and timely authorizations. The role requires 2–3 years in a customer service or healthcare setting, plus strong communication, prioritization, negotiation, and problem-solving.

Proficiency with Google Apps is a plus; position based in Metro Manila (Muntinlupa).

Qualifications

• Graduate of 4 years of any medical/allied course; Healthcare/Medical field preferred.
• 3 years college with 2 years in Customer Service or medical field acceptable.

Responsibilities

• Collaborate with ER staff to assess case urgency and direct only qualified emergencies to ER.
• Issue Letters of Authorization (LOA) promptly for ER visits and guide care redirects.
• Address member inquiries related to ER availment, eligibility, coverage, and procedures.
• Process initial LOA for In-Patient cases in collaboration with clinicians.
• Act as gatekeeper and screen charges to prevent unnecessary costs per policy memo.
• Explain benefits and review coverage/non-coverage; assist unaccompanied members.
• Promote and steer members to Primary Care Networks (PCNs).
• Enhance cost savings by directing non-emergency cases to suitable services.
• Support campaigns and operations during manpower shortages or BCP events.

Skills

Prioritization

Negotiation

Communication

Conflict resolution

Customer service

Product knowledge

Critical thinking

Adaptability

Google Apps

Education

Bachelor’s degree in Healthcare/Medical-related field

3 years college + 2 years customer service experience

Tools

Google Applications

Job description

2 - 3 Years

Manager

Job Description

Job Description: The following broad responsibility statements are representative of the basic expectations aboutthe role or function. Depending on business needs and exigencies, these responsibilitystatements may be modified. Critical to any leadership function is the need to demonstrateflexibility and agility in adapting to the changing requirements of the business.

1. Support members by collaborating with hospital ER staff to assess case urgency,ensuring that only qualified emergency cases, whether Outpatient or In-patient, aredirected to the Emergency Room. This involves coordinating with healthcareprofessionals to prioritize critical cases, and allocating resources for timely and effectivecare. The focus on prioritizing emergency cases aims to optimize ER efficiency andimprove patient outcomes.

2. Provide assistance to members during Emergency Room (ER) visits by efficient/ timelyissuance of Letters of Authorization (LOA) to facilitate access to medical services.Implement redirection strategies as needed to direct non-emergency cases to alternativehealthcare facilities or services. This includes offering guidance on available healthcareoptions, and ensuring smooth transitions to optimize the suitability and efficiency of caredelivery.

3. Handle various concerns and inquiries related to Emergency Room (ER) availment andmiscellaneous items. Provide assistance and clarification to members on ER services,eligibility, coverage, and procedures. By effectively addressing these concerns, ensuremembers are well-informed and supported, contributing to a positive patient experienceand optimal ER resource utilization.

4. Facilitate initial Letter of Authorization (LOA) for In-Patient Cases. Collaborate withhealthcare professionals to assess patient needs, compile required documentation, andcommunicate relevant information. Ensure timely and appropriate care upon admissionuntil discharge, promoting continuity of care and optimal patient outcomes.

5. Act as gatekeeper and screen for unnecessary charges in accordance with our memo.This involves carefully reviewing charges and expenses to ensure compliance withestablished guidelines and protocols. By diligently fulfilling this role, we aim to preventunnecessary costs and uphold financial accountability within the organization.

6. Provide detailed explanations of benefits and review coverage and non-coverage basedon their benefit provision. Additionally, offer direct assistance to members who areunaccompanied, addressing any questions or concerns they may have, ensuring theyreceive the necessary support and understanding.

7. Promotion and Steerage to our Primary Care Networks. Encourage and assist membersin visiting our Primary Care Networks (PCNs), providing full support and guidance. Thisincludes advocating for PCN benefits and helping members understand availableservices.

8. Enhance cost savings by directing non-emergency cases to more suitable healthcareservices or facilities. This includes evaluating case urgency and guiding individualstowards alternative care options. Through this approach, we strive to maximize resourceutilization, reduce unnecessary expenses, and promote overall efficiency and financialsustainability within the organization.9. Execute various campaigns and tasks as needed during manpower shortages, businesscontinuity planning (BCP) events, or when Service Level (SL) for other teams orsub-units are critically low, ensuring operations remain smooth and responsive to immediate demands.

DESIRED SKILLS AND COMPETENCIES

• Effective Prioritization and Timely Decision Making: Ability to prioritize tasks efficientlyand make timely decisions to address issues promptly.
• Assertive Negotiation and Influencing Skills: Capability to negotiate effectively andinfluence Maxicare business results positively.
• Empathetic and Concise Communication: Ability to communicate empathetically and skillin conveying information clearly and succinctly to ensure effective communication.
• Conflict Resolution and Interdisciplinary Collaboration: Proficiency in resolving conflictsand collaborating with interdisciplinary teams to achieve common goals.
• Efficient and Proactive Customer Service: Capacity to provide proactive andpersonalized customer service efficiently, demonstrating empathy and active listening.
• In-Depth Knowledge on Products, Policies, and Procedures: Thorough understanding ofMaxicare products, policies, and procedures, with attention to detail and a willingness toshare knowledge.
• Critical Thinking and Critical Decision-Making: Ability to think critically and make sounddecisions based on thorough analysis and evaluation.
• Adaptability and Ethical Standards: Flexible in adjustingt ochanging circumstances whilemaintaining patient confidentiality and adhering to ethical practices.
• Proficient in using Google Applications (Gmail, GSheets & etc.).

EDUCATIONAL REQUIREMENT

Graduate of 4 years of any medical and allied courses. A Bachelor's degree in aHealthcare or Medical-related field is preferred. Alternatively, candidates with at least 3years of college education with a minimum of 2 years experience in Customer Service,or work experience in the medical field.

EXPERIENCE AND TRAINING

• Preferably with at least 3 years experience in a customer service role.
• Preferred industry orientation: Healthcare, Insurance, Pharmaceuticals, FMCG, or anyservice-oriented industry
• Preferably with basic knowledge of medicines, the pathophysiology ofillnesses/diseases, and nursing intervention (if nurse).

Job Snapshot

Updated Date

29-07-2026

Job ID

Job_622

Section/Unit

Customer Care Department

Location