Medical Resource Manager

2 weeks ago


Manila, National Capital Region, Philippines MAESTRO HOLDINGS Full time
Job Description

The position is responsible for:

  1. Developing, implementing, and creating strategic plans primarily for utilization management;
  2. Providing leadership among PhilCare's Digimed doctors;
  3. Effectively communicating with internal and external partners on medical management of cases based on current best practices in the medical field and HMO business.

For utilization management to be effective, the position entails supervision, monitoring, and evaluation of IP, OP, and ER utilization in terms of medical necessity, leading to the creation of specific strategies for cost-efficient regulation and maximization of health insurance benefits. This also entails the application of best-in-class Customer Experience, especially in communicating with members regarding benefits and contract limitations. The position is also responsible for the accuracy of gatekeeping controls through the correct application of benefits based on contract and guidelines.

Job Specifications

Minimum Education: Graduate of Doctor of Medicine

Licensure: PRC board certified

Certifications: Certified member of Medical organization (PAFP)

Experience Required: Minimum of 5 years of relevant work experience in the HMO industry in a managerial capacity.

Competencies

Core: Proficiency in HMO practices with extensive experience in the following areas:

  1. Utilization Management
  2. Customer Service
  3. Strategic planning and project management
  4. People development and team collaboration
  5. Negotiation, mediation, and conflict resolution techniques

Technical: Medical knowledge in healthcare operations

Universal: Knowledge of MS Office applications

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