Patient Navigator (Medical Assistant Program Completion Required)

Resolve incoming calls concerning members' eligibility, benefits, provider information, clinical, and pharmacy needs; coordinate membership changes such as member's primary care physician and proactively engage member with their wellness plan options. Alignment Health is seeking a compassionate and detail oriented patient navigator to join their Access Primary Care Physicians clinic on Smoke Ranch Road in Las Vegas, NV.

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

Alignment Health is seeking a compassionate and detail oriented patient navigator to join their Access Primary Care Physicians clinic on Smoke Ranch Road in Las Vegas, NV. As a patient navigator, you will provide outreach and support to ensure all our members have access to the care they deserve. You will navigate our members through their health care and benefits, and connect the dots between our provider network, health plan operations, and supplemental vendors. You will be alongside our members every step of the way to ensure they are never alone in their healthcare journey and have the highest level of coordinated care. Patient navigators are active members of the health care team, addressing immediate needs and laying the groundwork for future and ongoing member support. This is a role for a passionate and experienced healthcare professional who understands the meaningful contribution they make to our members' healthcare outcomes.

Individuals with front and back office medical assistant experience and care coordination experience highly encouraged to apply!

Location: Smoke Ranch Clinic
Schedule: Monday - Friday, 7:30 AM - 4:00 PM

General Duties / Responsibilities

• Conduct patient outreach for new, termed, and transitioned patients
• Ensure member has access to PCP and specialists to coordinate care
• Educates member on gaps in care and assist with scheduling provider appointments
• Serve as the patient's liaison throughout the life cycle of the program by addressing program specific quality measures and adhering to company guidelines/standard operating procedures
• Make patient welcome calls on date of notification of assignment and/or discharge
• Mail letters and correspondence as needed
• Make appropriate and timely patient appointments, reminders, and confirmations
• Place regular / consistent outreaches to the patient
• Prepare, communicate, and follow through on patient flagpole/escalation communications to management
• Communicate with PCP with any member updates and requests
• Assist with obtaining medical records from any healthcare providers involved in care or hospitals
• Help members with any authorizations and referrals involved in their care plan
• Resolve incoming calls concerning members' eligibility, benefits, provider information, clinical, and pharmacy needs; coordinate membership changes such as member's primary care physician and proactively engage member with their wellness plan options.

SUPERVISORY RESPONSIBILITIES:

N/A

Minimum Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Minimum Experience:

• Medical assistant front and back office experience.
• Experience helping members navigate access to care through Medicare Advantage or HMO, including referrals and authorizations
• High-volume inbound customer service experience, particularly for health plan or Medicare "Member Services" roles in health plan and supplemental benefits preferred
• Telemarketing and / or member outreach experience preferred
• Specialized experience in escalation or resolution units preferred

Education/Licensure:

• High school diploma or general education degree (GED).
• Completion of an accredited medical assistant program.

Other Skills and Abilities:

• Independently motivated self-starter who can prioritize work assignments and make every day a productive day
• Team player willing to help and support colleagues, and do their part to support us all reaching our organizational goals
• Natural "teacher" with the ability to learn plans and describe / explain / educate healthcare coverage and services to our members
• Genuine passion for customer service
• Knowledge of ICD-10 and CPT codes.
• Computer proficient, able to type minimum 35 words per minute (WPM) by 10-key touch.
• Excellent written (email) and verbal (in-person and over the phone) communication skills.
• Language Skills: Able to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Able to write routine reports and correspondence. Able to speak effectively before groups of customers or employees of the organization.
• Reasoning Skills: Able to apply common sense understanding to carry out detailed but uninvolved written or verbal instructions. Able to deal with problems involving a few concrete variables in standardized situations.
• Computer Skills: Strong computer skills.

Preferred:

• Bilingual written and verbal fluency in English and Spanish, Korean, or Vietnamese.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Pay Range: $44,987.00 - $67,480.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/ . If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health's talent acquisition team, please email careers@ahcusa.com .