MediCard Phils., Inc.is one of the country's leading HMOand the only HMOfounded 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.

MediCardnow 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.

MediCardis currentlylooking 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

Field Patient Care Officer