Care Navigator

at ProviDRs Care in Wichita, Kansas, United States

Job Description

Job Description: Medical Assistant Care Navigator

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

Department: Integrated Health Management

Reports To: Director of Integrated Health Management

Position Overview:
The Medical Assistant Care Navigator supports members of a 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.

Key Duties and Responsibilities

• 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 treatment plans as outlined by their healthcare providers and case manager.
• Facilitate referrals, 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, 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 and claim processes to members, focusing on maximizing their 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 regulatory guidelines and policies, acting within the authorized scope of a medical assistant in Kansas.

Ability to Commute:

• Wichita, KS 67202 (Required)

Work Location: In person