Care Navigator Medical Assistant
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Job Summary
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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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 patients needs and ensure they receive high-quality appropriate care.
- Collaborative mindset working effectively with other team members across departments to achieve member outcomes.
Competitive hourly rate based on experience.
Benefits include Medical Insurance Dental insurance Vision insurance Employer paid life insurance 401k with 7% employer contribution PTO
Required Skills:
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 patients needs and ensure they receive high-quality appropriate care. Collaborative mindset working effectively with other team members across departments to achieve member outcomes.
Required Education:
Medical Assistant certificate or diplomaAt least 1 year of healthcare experienceCMA/CCMA certification preferredExperience with health plans care management or patient navigation preferred
