Position Title: Full-time
Care Navigator – Medical Assistant

Location:  200
W. Douglas, Ste. 900, Wichita, KS 67202 - Applicant must be able to work on-site

Department: Integrated
Health Management

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
   
• 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.
  

1. Care Coordination and Navigation
   
• 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.
  

1. Insurance and Benefits Support
   
• 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.
  

1. Documentation and Data Entry
   
• 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.
  

1. Health Education Support
   
• 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.
  

1. Compliance and Confidentiality
   
• 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

• Basic clinical
  assessment
  
• Understanding
  of preventive care and wellness programs
  
• Experience in
  health insurance, PPO, or TPA environments is a plus.
  
• 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