Medical Management Specialist I — RN (Non-Clinical Support)

Carelon Global Solutions Philippines Inc

Taguig

On-site

PHP 300,000 - 420,000

Full time

14 days+

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Job summary

Carelon Global Solutions Philippines Inc. is seeking a Medical Management Specialist I/ PHRN to support Medical Management and Operations teams with non-clinical tasks. You will gather case information, refer cases, provide program details, and maintain databases.

The role emphasizes administrative duties over clinical interpretation and requires a Philippines RN license. Candidates should have at least 1 year of admin and customer service experience and knowledge of managed care concepts.

Qualifications

Requires current Philippines RN license.
At least 1 year of administrative and customer service experience.
Knowledge of managed care or Medicaid/Medicare concepts.
Strong communication and problem-solving skills.

Responsibilities

Gathers clinical information regarding case and determines appropriate area to refer or assign case.
Provides information regarding network providers or general program information when requested.
May assist with complex cases.
May act as liaison between Medical Management and/or Operations and internal departments.
Maintains and updates tracking databases.
Prepares reports and documents all actions.
Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information.