Field Patient Care Officer (Cavite)

AIA Hong Kong and Macau; Cavite City; On-site; PHP 201,000 - 290,000; Full time

Job summary

MediCard Phils., Inc. is a leading HMO dedicated to service-oriented health care. The Field Patient Care Officer will help members access the right care at the right time and setting, guiding them through benefits and provider networks.

You will coordinate with healthcare providers, support approvals and authorizations, and strive to deliver compassionate, patient-centered service that aligns with MediCard's standards and brand promise.

Qualifications

• Engagement with healthcare members to access benefits and services.
• Ability to guide members through healthcare pathways and networks.
• Strong communication and empathy in handling member inquiries.

Responsibilities

• Serve as the primary contact for members within assigned facilities.
• Guide members in accessing appropriate services and providers.
• Explain coverage limits and benefit exclusions clearly.
• Support admissions, treatment, and discharge processes with care coordination.

Job description

## Field Patient Care Officer (Cavite)應徵: Cavite, PH-MPI: Cavite, PH-AIA Philippines: Full time: 今天刊登: JR-69044**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. 1. Healthcare Navigation Responsibilities 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 Responsibilities 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 Responsibilities 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 Responsibilities 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.*You must provide all requested information, including Personal Data, to be considered for this career opportunity. Failure to provide such information may influence the processing and outcome of your application. You are responsible for ensuring that the information you submit is accurate and up-to-date.*