Field Patient Care Navigator

AIA Shared Services; Mabalacat; On-site; PHP 279,000 - 446,000; Full time

Job summary

MediCard Phils., Inc. is seeking assertive, dynamic and energetic individuals to join our team for roles including Member Advocate, Healthcare Navigator, Care Coordinator, Utilization Steward and Brand Ambassador.

You will help members access the right care at the right time within our provider network and guide them through benefits, admissions, treatment and discharge. As a Healthcare Navigator, Care Coordinator, Utilization Steward and Brand Ambassador, you will ensure medical necessity,

Responsibilities

• Healthcare Navigation: Serve as the primary point of contact for members within assigned healthcare facilities.
• Healthcare Navigation: Guide members in accessing appropriate healthcare services and providers.
• Healthcare Navigation: Assist members in understanding healthcare benefits, limitations, and available options.
• Healthcare Navigation: Provide support throughout admission, confinement, treatment, and discharge processes.
• Healthcare Navigation: Facilitate referrals and coordination of care as needed.
• Healthcare Navigation: Assist members in navigating complex healthcare situations.
• Benefit Implementation and Management: Verify member eligibility and benefit coverage.
• Benefit Implementation and Management: Facilitate timely processing of approvals and authorizations.
• Benefit Implementation and Management: Explains the coverage, limitations and exclusions, as well as requirements.
• Benefit Implementation and Management: Ensure services rendered are within approved benefits and coverage guidelines.
• Benefit Implementation and Management: Support efficient claims and documentation processes.
• Medical Appropriateness and Care Coordination: Facilitate implementation of MediCard utilization management policies.
• Medical Appropriateness and Care Coordination: Coordinate with healthcare providers regarding covered healthcare services.
• Medical Appropriateness and Care Coordination: Support medically necessary and evidence-based healthcare practices.
• Medical Appropriateness and Care Coordination: Promote treatment in the most appropriate level of care.
• Medical Appropriateness and Care Coordination: Escalate complex medical necessity concerns to designated clinical teams.
• Member Experience Excellence: Deliver compassionate and professional member support.
• Member Experience Excellence: Practice active listening and empathy during member interactions.
• Member Experience Excellence: Manage concerns and complaints promptly.
• Member Experience Excellence: Conduct service recovery activities when necessary.
• Member Experience Excellence: Ensure every member interaction reflects MediCard's brand promise.
• Provider Relationship Management: Develop positive working relationships with hospital personnel and physicians.
• Provider Relationship Management: Promote collaborative problem-solving.
• Provider Relationship Management: Support provider awareness of MediCard processes.
• Provider Relationship Management: Participate in provider engagement activities.
• Provider Relationship Management: Gather provider feedback for service improvement.
• Operational and Compliance Excellence: Maintain accurate documentation and records.
• Operational and Compliance Excellence: Comply with Data Privacy Act requirements and company policies.
• Operational and Compliance Excellence: Adhere to established service level agreements (SLAs).
• Operational and Compliance Excellence: Ensure timely reporting and escalation of critical issues.
• Operational and Compliance Excellence: Participate in quality improvement initiatives.
• Brand Ambassador Responsibilities: Promote MediCard’s brand promise.
• Brand Ambassador Responsibilities: Educate members regarding Medicard’s services.
• Brand Ambassador Responsibilities: Participate in member education campaigns.
• Brand Ambassador Responsibilities: Support brand awareness initiatives within healthcare facilities.
• Brand Ambassador Responsibilities: Demonstrate professionalism and service excellence consistently.

Job description

MediCard Phils., Inc. is seeking assertive, dynamic and energetic individuals to join our team for roles including Member Advocate, Healthcare Navigator, Care Coordinator, Utilization Steward and Brand Ambassador.

You will help members access the right care at the right time within our provider network and guide them through benefits, admissions, treatment and discharge. As a Healthcare Navigator, Care Coordinator, Utilization Steward and Brand Ambassador, you will ensure medical necessity,