Healthcare Navigator & Member Advocate

AIA; Pasig; On-site; PHP 420,000 - 600,000; Full time

Job summary

MediCard Phils., Inc. seeks a proactive Liaison Officer to act as Care Partner and Member Advocate within healthcare facilities.

You will guide members through their healthcare journey, facilitate benefits, coordinate with providers, and promote quality outcomes while ensuring MediCard policies and utilization standards are followed. The LO role emphasizes delivering an exceptional member experience, maintaining privacy compliance, and collaborating with hospitals and physicians to streamline

Qualifications

• Bachelors degree in a healthcare field.
• Experience in HMO operations or hospital operations is preferred.
• Strong communication and patient-facing skills.

Responsibilities

• Healthcare Navigation: be the primary contact for members in assigned facilities; guide access to services; explain benefits and options; support admission, treatment and discharge; coordinate referrals.
• Benefit Implementation and Management: verify eligibility and coverage; facilitate approvals; explain coverage requirements; ensure services fall within approved benefits; support claims/documentation.
• Medical Appropriateness and Care Coordination: implement utilization management policies; coordinate with providers; promote evidence-based practices; escalate complex cases.
• Member Experience Excellence: deliver compassionate support; practice active listening; resolve concerns promptly; ensure experiences reflect MediCard brand.
• Provider Relationship Management: build positive relationships with hospitals and physicians; engage providers; gather feedback for service improvement.
• Operational and Compliance Excellence: maintain documentation; ensure data privacy compliance; meet SLAs; report issues promptly.
• Brand Ambassador Responsibilities: promote MediCard brand; educate members on services; participate in awareness campaigns; uphold professional standards.

Skills

Healthcare Navigation

Care Coordination

Member Advocacy

Provider Relations

Compliance & Privacy

Customer Service

SLA Management

Education

Bachelor's Degree in Nursing

Bachelor's Degree in Medical Technology

Bachelor's Degree in Physical Therapy

Bachelor's Degree in Pharmacy

Bachelor's Degree in Healthcare Administration

Bachelor's Degree in Allied Health Sciences

Other healthcare-related courses

Job description

MediCard Phils., Inc. seeks a proactive Liaison Officer to act as Care Partner and Member Advocate within healthcare facilities.

You will guide members through their healthcare journey, facilitate benefits, coordinate with providers, and promote quality outcomes while ensuring MediCard policies and utilization standards are followed. The LO role emphasizes delivering an exceptional member experience, maintaining privacy compliance, and collaborating with hospitals and physicians to streamline