Field Patient Care officer

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.

• Key Responsibilities
• 1. 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.

• Success Indicators
• High member satisfaction ratings
• Improved healthcare navigation experience
• Reduced member confusion and escalations

• 2. 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.

• Success Indicators
• Compliance with authorization turnaround times
• Reduced benefit-related complaints
• Accurate benefit application

• 3. 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.

• Success Indicators
• Appropriate utilization of healthcare resources
• Reduced unnecessary admissions and procedures
• Positive provider collaboration

• 4. 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.

• Success Indicators
• Member Satisfaction Score targets achieved
• Increased Net Promoter Score (NPS)
• Timely complaint resolution

• 5. 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.

• Success Indicators
• Positive provider satisfaction ratings
• Reduced operational disputes
• Improved provider collaboration

• 6. 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.

• Success Indicators
• Audit compliance
• Zero major privacy incidents
• SLA achievement

• 7. 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.

• Success Indicators
• Increased awareness of LO role
• Positive member and provider perception
• High brand compliance scores

• Key Performance Indicators (KPIs)
• Member Experience
• Operations
• Healthcare Navigation
• Brand and Engagement 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.