Medical Management Specialist I/ PHRN

Position Title: Medical Management Specialist I / PHRN

Responsibilities

• Provide non‑clinical support to the Medical Management and/or Operations areas.
• Gather clinical information regarding a case and determine the appropriate area for referral or assignment (utilization management, case management, QI, Med Review).
• Provide information regarding network providers or general program information when requested.
• Assist with complex cases when necessary.
• Act as liaison between Medical Management and/or Operations and internal departments.
• Maintain and update tracking databases.
• Prepare reports and document all actions.
• Responsibilities exclude conducting any utilization management review activities that require interpretation of clinical information.

Qualifications

• Current Philippines RN license.
• At least 1 year of administrative and customer‑service experi...