Care Navigator - Medical Assistant

Position Title: Full-time Care Navigator – Medical Assistant

Location:  200 W. Douglas, Ste. 900, Wichita, KS 67202

Reports To: Case Manager/Director of Integrated Health Management

Employment Type: Full-time

Hours: 10a – 7p – this is subject to vary or change with alternative shifts 8a – 5p or 9a -6p

The Medical Assistant Care Navigator supports members of a Preferred Provider Organization (PPO) network and Third-Party Administrator (TPA), assisting with navigation of healthcare services, benefits, and coordination of care. This role ensures seamless communication between members and providers, optimizing the member experience within the boundaries of the medical assistant scope of practice.

1. Member Outreach and Engagement
   
2. • Contact members to provide education on benefits, preventive health options, and available network resources.
     
   • Act as a primary point of contact for members, providing directions on how to access healthcare services, and schedule appointments.
     
   • Assist with coordinating referrals to healthcare providers, hospitals, urgent care, imaging, laboratories, durable medical equipment facilities, and home health agencies.
     
   • Assist members in navigating healthcare systems, explaining the roles of various providers, and facilitating the introduction to care teams as necessary.
     

2. Care Coordination and Navigation
   
3. • Assist members in understanding their care plans as outlined by the RN case manager.
     
   • Facilitate referrals within the PPO network and TPA, ensuring that members receive care from in-network providers and facilities to maximize benefits.
     
   • Coordinate necessary follow-up services, ensure adherence to medication and treatment regimes, and send reminders to ensure continuity of care.
     
   • Address member questions or concerns within established protocols and escalate clinical issues to the appropriate healthcare professionals when necessary.
     
   • Perform administrative duties, including answering calls, managing member inquiries, and organizing resources to support the care navigation process.
     
   • Work closely with healthcare providers, case manager, utilization review nurse, and other members of the care team to align member care goals and share updates on member progress.
     

3. Insurance and Benefits Support
   
4. • Explain basic insurance benefits to members, focusing on maximizing their PPO and TPA coverage.
     
   • Address common questions related to network coverage, cost-sharing, and claims processes within established guidelines.
     

4. Documentation and Data Entry
   
5. • Maintain up-to-date records and accurately document member interactions, referrals, care coordination, health education provided, and other relevant information into the electronic systems.
     
   • Assist with compiling reports on member navigation activities, outreach success, outcomes, and member satisfaction metrics as required by the care management team.
     

5. Health Education Support
   
6. • Provide general health information, preventive care tips, and resources to members to encourage informed healthcare decisions.
     
   • Provide information on wellness programs, preventive screenings, and chronic condition management as directed by care management guidelines.
     
   • Provide education on topics such as diet, exercise, and stress management to promote healthier lifestyles.
     

6. Compliance and Confidentiality
   
7. • Maintain compliance with all HIPAA regulations, ensuring the confidentiality and privacy of member health information.
     
   • Adhere strictly to TPA, PPO, and regulatory guidelines and policies, acting within the authorized scope of a medical assistant in Kansas.
     

Requirements

• Graduate of an accredited Medical Assistant program
  
• Current Medical Assistant certification preferred (CMA, RMA, NCMA, CCMA, or equivalent)
  
• Additional training in care coordination, population health, chronic disease management, patient education, or case management is preferred
  

• Minimum of two (2) years of healthcare experience required.
  
• Experience in care coordination, care navigation, population health, case management support, or patient outreach preferred.
  
• Basic clinical assessment skills are required
  
• Understanding of preventive care and wellness programs
  
• Experience in health insurance, PPO, or TPA environments is a plus.
  
• Proficiency with Microsoft Office Applications is required
  
• Strong written and verbal communication skills as well as organizational skills with a member-focused approach.
  
• Ability to advocate for the patient’s needs and ensure they receive high-quality, appropriate care.
  
• Collaborative mindset, working effectively with other team members across departments to achieve member outcomes.
  

Benefits

·        Competitive hourly rate based on experience.

·        Benefits include Medical Insurance, Dental insurance, Vision insurance, Employer paid life insurance, 401k with 7% employer contribution, PTO