Concierge Care Management Specialist

About the role

The Concierge Care Management Specialist reviews VIP member medical requests, determines the appropriate medical specialty for referrals, and serves as a clinical resource for the Concierge Service.

Key responsibilities

• Review incoming VIP service requests and medical documentation to identify the exact medical specialty required.
• Evaluate clinical notes, member histories, and medical records to ensure completeness and accuracy before finalizing referrals.
• Provide clinical guidance to non‑clinical Concierge personnel, clarifying diagnoses and specialist criteria.
• Contact insureds, providers, and facilities to obtain missing clinical data needed for case evaluation.
• Coordinate with internal network management to align recommended specialties with available providers and track routing accuracy.

Required profile

• Bachelor’s degree in Nursing Sciences.
• At least three years of clinical nursing experience, preferably in triage, utilization review, or care coordination.
• Valid nursing license and registration with the Association of Nursing Professionals of Puerto Rico.
• Advanced proficiency in both Spanish and English (written and verbal).

Required skills

• Clinical assessment and referral determination.
• Medical documentation review and validation.
• Knowledge of specialty networks and provider availability.