In-house Patient Care Officer
Core
Guide members through healthcare pathways, verify eligibility, coordinate with providers, and manage utilization to ensure appropriate care access and cost efficiency.
Role type
In-house Patient Care Officer (Healthcare Navigator & Utilization Steward)
Builds
Member healthcare journeys and provider-stakeholder coordination
Domain
Health Insurance / Managed Care
Deliverable
client delivery
Required skills
Healthcare navigation, utilization management, benefit verification, 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 customer concerns, complaints, and escalations; Assist in discharge planning and continuity of care.
