Field Patient Care Officer

AIA; Calamba; On-site; PHP 320,000 - 450,000; Full time

Job summary

MediCard Phils., Inc. invites applications for roles focused on guiding members through healthcare benefits and provider networks. You will help members navigate admissions, treatments, and discharge processes while ensuring services align with benefits and approvals.

The positions emphasize compassionate member support, effective communication, and coordination with hospitals and physicians to enhance the healthcare experience.

Qualifications

• Strong communication and interpersonal skills.
• Ability to navigate healthcare systems and explain benefits clearly.
• Empathy and active listening in member interactions.

Responsibilities

• Serve as the primary contact for MediCard members within assigned facilities.
• Guide members to access appropriate healthcare services and providers.
• Explain benefits, limitations, and requirements to members clearly.
• Assist with admissions, confinement, treatment, and discharge processes.
• Coordinate referrals and care coordination as needed.
• Ensure services rendered align with approved benefits and coverage guidelines.
• Deliver compassionate and professional member support and resolve concerns promptly.

Job description

MediCard Phils., Inc. is one of the country's leading HMOand the only HMOfounded and run by Doctors. Since its inception, the concept of service-oriented total health care has been the molding ideal of MediCard. The competition is vast, and the benefits being offered by the competitors are tempting. However, MEDICard has taken the lead in providing innovative and productive ideas that cut down the cost of health maintenance without compromising its quality.

MediCard now boasts of more than half a million members and over 54,000 accredited doctors in over 1,000 hospitals and clinics nationwide. It also operates 16 MediCard free-standing clinics that provide services at par with those offered by hospitals minus the confinement.

MediCard is currentlylooking for assertive, dynamic and energetic individuals to fill up the following vacancy:

Primary Purpose of the Role

To help members access:
The right care
At the right time
In the right care setting
At the right cost while ensuring a positive healthcare experience that strengthens confidence in MediCard's services.

Member Advocate

Supports members in understanding and navigating healthcare benefits and services.

Healthcare Navigator

Guides members through healthcare pathways and provider networks.

Care Coordinator

Facilitates efficient communication among members, healthcare providers, and MediCard.

Utilization Steward

Ensures healthcare services are medically necessary, appropriate, and aligned with benefit entitlements.

Brand Ambassador

Represents MediCard's commitment to service excellence and member-centered care.

Key Responsibilities

1. Healthcare Navigation
   Serve as the primary point of contact for members within assigned healthcare facilities.
   Guide members in accessing appropriate healthcare services and providers.
   Assist members in understanding healthcare benefits, limitations, and available options.
   Provide support throughout admission, confinement, treatment, and discharge processes.
   Facilitate referrals and coordination of care as needed.
   Assist members in navigating complex healthcare situations.
   Success Indicators
   High member satisfaction ratings
   Improved healthcare navigation experience
   Reduced member confusion and escalations
   
2. Benefit Implementation and Management
   Verify member eligibility and benefit coverage.
   Facilitate timely processing of approvals and authorizations.
   Explains the coverage, limitations and exclusions, as well as requirements.
   Ensure services rendered are within approved benefits and coverage guidelines.
   Support efficient claims and documentation processes.
   Success Indicators
   Compliance with authorization turnaround times
   Reduced benefit-related complaints
   Accurate benefit application
   
3. Medical Appropriateness and Care Coordination
   Facilitate implementation of MediCard utilization management policies.
   Coordinate with healthcare providers regarding covered healthcare services.
   Support medically necessary and evidence-based healthcare practices.
   Promote treatment in the most appropriate level of care.
   Escalate complex medical necessity concerns to designated clinical teams.
   Success Indicators
   Appropriate utilization of healthcare resources
   Reduced unnecessary admissions and procedures
   Positive provider collaboration
   
4. Member Experience Excellence
   Deliver compassionate and professional member support.
   Practice active listening and empathy during member interactions.
   Manage concerns and complaints promptly.
   Conduct service recovery activities when necessary.
   Ensure every member interaction reflects MediCard's brand promise.
   Success Indicators
   Member Satisfaction Score targets achieved
   Increased Net Promoter Score (NPS)
   Timely complaint resolution
   
5. Provider Relationship Management
   Develop positive working relationships with hospital personnel and physicians.
   Promote collaborative problem-solving.
   Support provider awareness of MediCard processes.
   Participate in provider engagement activities.
   Gather provider feedback for service improvement.
   Success Indicators
   Positive provider satisfaction ratings
   Reduced operational disputes
   Improved provider collaboration
   
6. Operational and Compliance Excellence
   Maintain accurate documentation and records.
   Comply with Data Privacy Act requirements and company policies.
   Adhere to established service level agreements (SLAs).
   Ensure timely reporting and escalation of critical issues.
   Participate in quality improvement initiatives.
   Success Indicators
   Audit compliance
   Zero major privacy incidents
   SLA achievement
   
7. Brand Ambassador Responsibilities
   Promote MediCard's brand promise.
   Educate members regarding Medicard's services.
   Participate in member education campaigns.
   Support brand awareness initiatives within healthcare facilities.
   Demonstrate professionalism and service excellence consistently.
   Success Indicators
   Increased awareness of LO role
   Positive member and provider perception
   High brand compliance scores
   Key Performance Indicators (KPIs)
   Member Experience
   Operations
   Healthcare Navigation
   Brand and Engagement