Especialista Concierge en Gestión de Cuidado VIP

MCS Health; San Juan (PR); On-site; USD 60,000 - 85,000; Full time

Job summary

MCS Health in Puerto Rico is seeking a Concierge Care Management Specialist to review VIP member medical requests and assign the correct specialty referrals to ensure timely access to services. You will serve as a clinical resource, evaluate records, and collaborate with internal teams to streamline care routing, while maintaining compliance with policies and service level agreements.

In this role you will work closely with healthcare providers and facilities to obtain necessary information,

Qualifications

• Bachelor’s degree in Nursing Sciences required.
• At least three (3) years of clinical nursing experience.
• A valid License and Registration of Nurse & Association Nursing Professionals of Puerto Rico are required.

Responsibilities

• Identify exact medical specialty for member referrals.
• Review clinical notes and histories for completeness and accuracy.
• Clarify complex diagnoses and specialist criteria for Concierge staff.
• Contact insureds, providers, and facilities to obtain missing data.
• Ensure care aligns with service levels and medical necessity.
• Coordinate with network management to align referrals with available providers.
• Support special clinical or operational projects and VIP member relationships.
• Collaborate with internal departments and external partners to address needs.

Skills

Clinical nursing

Care coordination

Medical terminology

Communication

Education

Bachelor’s degree in Nursing Sciences

Job description

MCS Health in Puerto Rico is seeking a Concierge Care Management Specialist to review VIP member medical requests and assign the correct specialty referrals to ensure timely access to services. You will serve as a clinical resource, evaluate records, and collaborate with internal teams to streamline care routing, while maintaining compliance with policies and service level agreements.

In this role you will work closely with healthcare providers and facilities to obtain necessary information,