In-house Patient Care Officer
Core
Acts as the face of MediCard within healthcare facilities, guiding members through their healthcare journey, facilitating benefit utilization, and coordinating with healthcare providers to ensure compliance with policies and medical necessity standards.
Role type
In-house Patient Care Officer (Healthcare Navigator & Utilization Steward)
Builds
Member healthcare access pathways and efficient utilization of MediCard benefits
Domain
Health Insurance / Managed Care
Required skills
Member eligibility verification, benefit coverage explanation, authorization processing, care coordination, utilization management, stakeholder communication, virtual channel support
Preferred skills
Active listening, empathy, service recovery, discharge planning, provider relationship management
Technologies
Virtual channels (phone, email, chat, video consultation)
Responsibilities
Verify member eligibility and benefit coverage; Facilitate timely processing of approvals and authorizations; Guide members through healthcare access processes; Coordinate with providers and hospital stakeholders; Promote appropriate and medically necessary utilization of services; Manage member concerns and complaints via virtual channels.
Seniority
Individual Contributor