Medical Management Specialist I/ PHRN
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LocationPHL-Taguig City-Alliance Global Tower, 11th Ave, Corner 36th St, Uptown Bonifacio
Work modeon-site
Typefull-time
SeniorityEntry
Experience1+ yrs
Company size1,001–5,000 people
PostedSep 8, 2026 · 2mo ago
Verified live1d ago
At a glanceSummarised by Seekless from the posting.
Current Philippines RN license
1 year of administrative and customer service experience with knowledge of managed care or Medicaid/Medicare concepts
Strong oral, written and interpersonal communication skills
Problem-solving skills
Facilitation skills
Analytical skills
Position Title:
Medical Management Specialist I/ PHRN
Shift:
Job Description:
Responsible for providing non-clinical support to the Medical Management and/or Operations areas. Primary duties may include, but are not limited to: Gathers clinical information regarding case and determines appropriate area to refer or assign case (utilization management, case management, QI, Med Review). Provides information regarding network providers or general program information when requested. May assist with complex cases. May act as liaison between Medical Management and/or Operations and internal departments. Maintains and updates tracking databases. Prepares reports and documents all actions. Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information. Requires a current Philippines RN license; 1 year of administrative and customer service experience with knowledge of managed care or Medicaid/Medicare concepts; or any combination of education and experience, which would provide an equivalent background. For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
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