Allied Healthcare Specialist

5 days ago


Quezon City, Philippines MetHealth Full time

Responsibilities

  • Conduct in-depth utilization reviews to ensure medical necessity and appropriate care
  • Assess eligibility and validity of medical claims with accuracy and compliance
  • Collaborate with healthcare providers to coordinate patient care plans and discharge processes
  • Communicate results and next steps to patients regarding claims and coverage
  • Analyze clinical data to improve patient care quality and operational efficiency
Qualifications
  • Graduate of Allied Sciences, Social Work, Psychology, Human Services, or similar (e.g., PT, MedTech, Nutrition, Pharmacy, RadTech)
  • With at least 1 year of direct patient care experience – in long-term care, hospitals, case management, or community-based healthcare
  • Familiar with BPO healthcare processes , Medicare/Medicaid , and managed care organizations
  • HIV counselling experience required
  • Active PRC License required
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