Medical Assistant Care Navigator

Medical Assistant Care Navigator

Department: Integrated Health Management
Employment Type: Full-Time
Schedule: MondayFriday Day Shift hours may vary
Work Location: On-Site Wichita Kansas
Reports To: Integrated Health Management Supervisor
FLSA Status: Non-Exempt/Hourly

Position Summary

We are seeking a motivated and highly organized Medical Assistant Care Navigator to join our Integrated Health Management team.

This is a unique opportunity for a Medical Assistant who wants to expand beyond the traditional clinic setting and work within the health plan and care management environment. Our Care Navigators help members understand and access their healthcare resources while working closely with RN Case Managers Utilization Review Nurses Customer Service Network Operations healthcare providers and other internal and external partners.

The Care Navigator assists with member outreach care coordination Centers of Value placement provider steerage Case Management intake utilization review support population health data review medical record retrieval DME coordination and employer-group reporting.

This position works within a collaborative department led by a Supervisor Manager and Director of Integrated Health Management.

What Youll Do

Member Care Navigation

• Help members navigate healthcare services providers facilities and available health plan resources.
  
• Assist members in locating appropriate in-network and cost-effective providers and facilities.
  
• Coordinate placement of eligible members at designated Centers of Value (COV) for certain procedures and services.
  
• Perform provider and facility steerage according to established health plan and network guidelines.
  
• Help identify and resolve barriers that may prevent members from accessing appropriate healthcare services.
  
• Assist members with obtaining durable medical equipment (DME) supplies and other healthcare resources.
  
• Conduct outbound member outreach and follow-up calls.
  
• Provide ongoing follow-up to designated low-risk members according to established protocols.
  

Case Management Support

• Complete initial intake calls for members enrolling in Case Management.
  
• Gather demographic medical medication provider social and other information needed by the RN Case Manager.
  
• Educate members about the Case Management program and available resources.
  
• Coordinate or schedule follow-up with the RN Case Manager.
  
• Assist RN Case Managers with provider outreach medical records appointment coordination and other care coordination activities.
  
• Identify changes or concerns during member interactions and escalate them to an RN when appropriate.
  

Utilization Review Support

• Monitor designated precertification/prior authorization email inboxes and voicemail queues.
  
• Route incoming authorization requests and clinical documentation to the appropriate Utilization Review Nurse.
  
• Assist with obtaining medical records and missing documentation needed for utilization review.
  
• Contact provider offices and facilities regarding outstanding records or administrative information.
  
• Track pending requests and follow up on outstanding documentation.
  
• Recognize urgent or time-sensitive requests and escalate them promptly to the appropriate UR Nurse.
  

Population Health & Data Review

• Review Clinigence and other population health and utilization data to identify members who may benefit from outreach or additional support.
  
• Review designated diagnosis utilization high-cost and other trigger reports according to established criteria.
  
• Research identified members using available systems and determine the appropriate workflow or referral based on established guidelines.
  
• Refer potentially high-risk high-cost or clinically complex members to the appropriate RN for review.
  
• Track referrals outreach attempts interventions and outcomes.
  

Provider & Medical Record Coordination

• Request medical records and clinical documentation from physician offices hospitals facilities and other healthcare providers.
  
• Follow up on outstanding medical record requests.
  
• Coordinate with providers and facilities regarding administrative and care coordination needs.
  
• Route clinical documentation to the appropriate RN or department for review.
  

Employer Group Reporting

• Assist with preparing routine and ad hoc reports for self-funded employer health plans.
  
• Compile and validate Care Navigation Case Management utilization outreach steerage and program activity data.
  
• Assist with departmental KPI and performance reporting.
  
• Research discrepancies and help ensure information is accurate before reports are finalized.
  
• Maintain confidentiality of member and employer information.
  

Network & Customer Service Support

• Collaborate with Network staff on provider research member access issues provider availability and steerage opportunities.
  
• Research provider participation and network status using available systems.
  
• Assist with provider outreach and special network initiatives.
  
• Support Customer Service Representatives with questions related to Care Navigation Case Management Centers of Value provider steerage and departmental processes.
  
• Assist Customer Service or Network Operations with additional duties during periods of increased volume or as business needs require.
  

Skills That Will Help You Succeed

Were looking for someone who is:

• Member-focused and compassionate
  
• Comfortable making outbound telephone calls
  
• Organized and detail-oriented
  
• Able to manage competing priorities
  
• Comfortable working with healthcare data and reports
  
• Confident communicating with physician offices and healthcare facilities
  
• Able to recognize when an issue needs to be escalated to a nurse
  
• A strong problem-solver
  
• Dependable and accountable
  
• Comfortable working independently and as part of an interdisciplinary team
  
• Interested in learning how self-funded health plans utilization management case management and healthcare networks operate
  

Scope of the Care Navigator Role

The Care Navigator provides member navigation outreach coordination data review and administrative support. Care Navigators do not independently make medical necessity determinations adverse utilization review determinations diagnoses nursing assessments or treatment recommendations.

Clinical concerns and decisions requiring licensed clinical judgment are escalated to an RN Case Manager Utilization Review Nurse or other appropriate licensed professional.

Schedule & Work Environment

• Full-time position
  
• Monday through Friday Day shift hours may vary
  
• On-site position in Wichita Kansas
  
• Primarily office-based work
  
• Frequent telephone and electronic communication with members providers facilities and internal teams
  
• Regular use of multiple healthcare and administrative systems
  
• Fast-paced environment requiring effective prioritization and follow-through
  

Why Join Us

This position offers Medical Assistants an opportunity to use their healthcare knowledge in a different way.

Instead of working exclusively in a traditional physician office or clinical setting youll become part of a team that helps members navigate the healthcare system identify appropriate resources access quality care and better understand the options available through their health plan.

Youll work alongside experienced RN Case Managers and Utilization Review Nurses while gaining exposure to areas of healthcare that many Medical Assistants do not encounter in traditional clinical roles including:

• Self-funded employer health plans
  
• Care Management
  
• Utilization Review
  
• Population health
  
• Healthcare data and analytics
  
• Provider networks
  
• Centers of Value
  
• Healthcare cost containment
  
• Member steerage and navigation
  
• Employer health plan reporting
  

This role is an excellent opportunity for a Medical Assistant who enjoys helping people solving problems coordinating care working with healthcare data and developing a broader understanding of how healthcare is delivered and financed.

Our Ideal Candidate

Our ideal Care Navigator doesnt simply complete tasksthey take ownership of helping move a members healthcare needs forward.

You may be a great fit if youre curious resourceful comfortable asking questions willing to make phone calls able to follow through until an issue is resolved and know when something needs to be escalated.

If you are a Medical Assistant who enjoys helping patients but are interested in moving beyond the traditional clinical setting we encourage you to apply.

Required Qualifications

• High school diploma or equivalent.
  
• Completion of a Medical Assistant training program.
  
• Knowledge of basic medical terminology.
  
• Strong computer skills and ability to learn multiple healthcare software systems.
  
• Excellent verbal and written communication skills.
  
• Strong organizational skills and attention to detail.
  
• Ability to manage multiple priorities in a fast-paced environment.
  
• Ability to communicate professionally with members healthcare providers and internal departments.
  
• Ability to maintain confidentiality and appropriately handle protected health information (PHI).
  

• Certified or Registered Medical Assistant (CMA RMA CCMA or equivalent).
  At least one year of healthcare experience.
• Previous experience with patient/member outreach or care coordination.
  
• Experience working with health insurance a health plan TPA provider network population health prior authorization utilization management or Case Management.
  
• Experience requesting and reviewing medical records.
  
• Experience working with healthcare data reports or electronic health information systems.
  

Compensation

Final compensation may be based on experience education certification and other job-related qualifications.

Benefits

Eligible full-time employees may receive a comprehensive benefits package that includes:

• Medical insurance
  
• Dental insurance
  
• Vision insurance
  
• Employer-sponsored 401(k) retirement plan
  
• Paid time off (PTO)
  
• Paid holidays
  
• Additional company-sponsored benefits and employee programs as applicable
  

Specific benefit eligibility coverage waiting periods employer contributions and plan provisions are governed by the applicable benefit plan documents and company policies.