Patient Care Officer (Calabarzon)

MediCard Phils., Inc.; Calabarzon; On-site; PHP 420,000 - 540,000; Full time

Job summary

MediCard Phils., Inc. is seeking a healthcare navigation specialist to serve as the primary contact for members in assigned facilities, guiding access to services, explaining benefits, and supporting admission through discharge.

Deployment locations include Pampanga, Cebu, Cavite, Batangas, and nearby areas. MediCard is an Equal Opportunity Employer committed to inclusion and diversity in the workplace.

Qualifications

• Bachelor's degree required in a healthcare field (Nursing, Medical Technology, Physical Therapy, Pharmacy, Healthcare Administration, Allied Health Sciences or related).
• Licensed/registered healthcare professional preferred (RN or equivalent).
• Minimum 2–3 years in HMO operations, hospital operations, utilization management, or case management.

Responsibilities

• Serve as the primary contact for members within assigned healthcare facilities.
• Guide members in accessing appropriate healthcare services and providers.
• Assist members in understanding benefits, limitations, and options.
• Support admission, confinement, treatment, and discharge processes.
• Coordinate referrals and care with providers.

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

DUTIES & RESPONSIBILITIES

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.

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.

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.

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.

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.

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.

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.

MINIMUM QUALIFICATIONS

Education Required

• Bachelor's Degree in:
• Nursing
• Medical Technology
• Physical Therapy
• Pharmacy
• Healthcare Administration
• Allied Health Sciences
• Other healthcare-related courses

Education Preferred

• Registered Nurse (RN)
• Other licensed healthcare professional

Experience Required

• Minimum 2–3 years experience in:
• HMO Operations
• Hospital Operations
• Utilization Management
• Case Management
• Patient Relations
• Healthcare Customer Service

Experience Preferred

• Experience within HMO or managed healthcare environment
• Experience in member engagement and care coordination
• Experience working with physicians and hospital administrators

Deployment Locations: Pampanga, Cebu, Cavite, Batangas, and TWC. Applicants must be willing to be assigned to any of the listed locations.

MediCard is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

At MediCard, we believe that diversity and inclusion are essential to fostering innovation, collaboration, and growth. We are committed to creating a workplace where everyone, regardless of gender, race, ethnicity, sexual orientation, disability, or any other characteristic, feels valued and empowered to contribute their unique perspectives and talents.

Our inclusive hiring practices ensure that we attract, hire, and retain the best talent from all backgrounds. We strive to provide equal opportunities for all candidates and promote a culture of respect, fairness, and transparency. We are dedicated to continuously improving our processes and policies to eliminate biases and barriers, ensuring that every employee has the support and resources they need to thrive.