Field Patient Care Officer

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 one of the country's leading HMO and the only HMO founded 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 currently looking 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