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:
Responsible for providing assistance to all confined members from admission till discharge.
Handling requirements that can be settled through coordination with some units at the Head Office and answers telephone inquiries.
DUTIES & 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
MINIMUM QUALIFICATIONS
Education Required
. Bachelor's Degree in:
. Nursing
. Medical Technology
. Physical Therapy
. Pharmacy
. Healthcare Administration
. Allied Health Sciences
. Other healthcare-related courses
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
Preferred
. Experience within HMO or managed healthcare environment
. Experience in member engagement and care coordination
. Experience working with physicians and hospital administrators
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, age, 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.
MediCard is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
Join MediCard Now!
