Medical Assistant - Care Navigator

MedicalAssistant – Care Navigator

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

PositionSummary

Weare seeking a motivated and highly organized Medical Assistant – CareNavigator to join our Integrated Health Management team.

Thisis a unique opportunity for a Medical Assistant who wants to expand beyond thetraditional clinic setting and work within the health plan and care managementenvironment. Our Care Navigators help members understand and access theirhealthcare resources while working closely with RN Case Managers, UtilizationReview Nurses, Customer Service, Network Operations, healthcare providers, andother internal and external partners.

TheCare Navigator assists with member outreach, care coordination, Centers ofValue placement, provider steerage, Case Management intake, utilization reviewsupport, population health data review, medical record retrieval, DMEcoordination, and employer-group reporting.

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

WhatYou'll Do

MemberCare 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.
  

CaseManagement 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.
  

UtilizationReview 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.
  

PopulationHealth & 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.
  

EmployerGroup 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.
  

SkillsThat Will Help You Succeed

We're lookingfor 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 ofthe Care Navigator Role

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

Clinicalconcerns and decisions requiring licensed clinical judgment are escalated to anRN Case Manager, Utilization Review Nurse, or other appropriate licensedprofessional.

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 JoinUs?

Thisposition offers Medical Assistants an opportunity to use their healthcareknowledge in a different way.

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

You'llwork alongside experienced RN Case Managers and Utilization Review Nurses while gaining exposure to areas of healthcare that many Medical Assistants donot 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
  

Thisrole is an excellent opportunity for a Medical Assistant who enjoys helpingpeople, solving problems, coordinating care, working with healthcare data, anddeveloping a broader understanding of how healthcare is delivered and financed.

Our IdealCandidate

Ourideal Care Navigator doesn't simply complete tasks—they take ownership ofhelping move a member's healthcare needs forward.

Youmay be a great fit if you're curious, resourceful, comfortable askingquestions, willing to make phone calls, able to follow through until an issueis resolved, and know when something needs to be escalated.

Ifyou are a Medical Assistant who enjoys helping patients but are interested inmoving beyond the traditional clinical setting, we encourage you to apply.

Requirements

RequiredQualifications

• 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.
  

Benefits

Compensation

Finalcompensation may be based on experience, education, certification, and otherjob-related qualifications.

Benefits

Eligiblefull-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
  

Specificbenefit eligibility, coverage, waiting periods, employer contributions, andplan provisions are governed by the applicable benefit plan documents andcompany policies.