Care Navigator (Part-Time)

This job was posted by https://www.kansasworks.com : For more

information, please see: https://www.kansasworks.com/jobs/13351717

• Job Description:** Medical Assistant Care Navigator - Part-time
  
  

***Applicant MUST be a current Medical Assistant.***

• 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**

**Data Collection, Analysis, and Reporting Responsibilities**

• Collect, organize, and maintain accurate data related to member
  
  

interactions, member engagement in key programs, member

satisfaction, case management activities, and program utilization.

• Track and monitor established Key Performance Indicators (KPIs) and
  
  

other performance metrics to evaluate program effectiveness, member

engagement, and team productivity.

• Conduct data analysis to identify trends, gaps, and opportunities
  
  

for improvement in utilization review, care navigation and case

management processes.

• Prepare and distribute regular reports (weekly, monthly, and
  
  

quarterly) summarizing performance outcomes, member engagement

statistics, and progress toward departmental goals.

• Collaborate with the Care Navigator, Case Manager, Utilization
  
  

Review Nurse, and Director of Integrated Health Management to

interpret data findings and recommend evidence-based improvements.

• Assist leadership in developing dashboards, scorecards, and
  
  

presentations to support decision-making and demonstrate program

impact to internal and external stakeholders.

• Support quality improvement initiatives by providing accurate data
  
  

insights and feedback to enhance member outcomes and operational

efficiency.

**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.

• Conduct necessary follow-up services for non-high risk and
  
  

non-complex members, 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.

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