Healthcare Utilization Specialist

4 weeks ago


Makati City, National Capital Region, Philippines Metacom Business Process Outsourcing Solutions Full time

At Metacom Business Process Outsourcing Solutions, we are seeking a highly skilled Healthcare Utilization Specialist to join our team. In this role, you will play a critical part in ensuring the delivery of high-quality patient care.

Key Responsibilities:

  • We require a dedicated professional who can conduct thorough utilization reviews to determine if patients are receiving appropriate care for their condition.
  • You will need to consult with medical and treatment staff to gather information regarding client diagnosis, medical justification, length of treatment, and case documentation.
  • In close collaboration with physicians, you will ascertain their plans for timely discharge and communicate these details effectively.
  • The successful candidate will be responsible for handling inbound and outbound calls from patients and healthcare providers.
  • You will analyze medical claims to determine eligibility and coordinate with providers and specialists to assess the validity of these claims.

About the Role:

This is an exciting opportunity to work in a dynamic environment where no two days are the same. As a Healthcare Utilization Specialist, you will have the chance to make a real difference in the lives of patients by ensuring they receive the best possible care.

Benefits:

  • A competitive estimated salary of $63,500 - $80,000 per year, depending on experience.
  • A comprehensive benefits package that includes health insurance, retirement savings, and paid time off.
  • The opportunity to work with a talented team of professionals who are passionate about delivering exceptional results.


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