In-house Patient Care Officer
Core
Guide members through healthcare pathways, verify eligibility, and coordinate care to ensure appropriate utilization of MediCard benefits.
Role type
In-house Patient Care Officer (Healthcare Navigator & Utilization Steward)
Builds
Member access to right care at right time/cost via virtual channels
Domain
Health Insurance / Managed Care
Deliverable
client delivery
Required skills
Healthcare navigation, benefit verification, utilization management, care coordination, stakeholder communication, case management
Preferred skills
Virtual channel expertise, service recovery, discharge planning
Technologies
Virtual consultation platforms, digital communication channels
Responsibilities
Verify member eligibility and benefit coverage; Facilitate timely processing of approvals and authorizations; Guide members through authorization and healthcare access processes; Coordinate with providers, hospitals, and internal clinical teams; Manage member concerns, complaints, and escalations; Assist in discharge planning and continuity of care.
