Healthcare Navigator/ Targeted Case Manager

WESTCARE KENTUCKY INC; Pikeville (KY); On-site; USD 35,000 - 52,000; Full time

Job summary

WestCare Kentucky Inc. in Pikeville, KY seeks a Healthcare Navigator/Targeted Case Manager to help program participants obtain medical coverage, manage prior authorizations, and connect clients with community resources.

You will document encounters in the EMR, maintain required timelines, collaborate with Medicaid officials and area providers, and support participants toward their health and social goals. The role requires strong teamwork, attention to detail, and excellent communication.

Qualifications

• Bachelor's degree in Human Services, Social Work or related field required.
• Targeted Case Management certification required.
• High School Diploma or equivalent required.

Responsibilities

• Enroll or reenroll eligible individuals into health insurance plans, including Medicaid.
• Obtain and track prior authorizations for services.
• Document each client encounter in the EMR and maintain timely records.
• Input data into EMR including demographics, insurance, treatment plans, and case notes.
• Coordinate with program leadership and prepare reports as needed.

Skills

Verbal comm

Written comm

Team collaboration

Resource awareness

Documentation basics

MS Office

Education

Bachelor's degree in Human Services / Social Work or related field

Targeted Case Management certification

High School Diploma or equivalent

Tools

Microsoft Word

Excel

Outlook

Job description

Position Summary

The Healthcare Navigator/ Targeted Case Manager is responsible for assisting potential program participants obtain medical insurance coverage, obtaining and maintaining prior authorizations, identifying community resources, maintaining appropriate timely documentation, and maintaining the electronic health record(EHR) of clients served Essential Job Functions include those listed below.

Essential Job Functions

• Helps enroll or reenroll eligible individuals into health insurance plans including Medicaid across multiple programs.
• Assists in obtaining and tracking prior authorization’s for services.
• Locates and connects clients with community assistance support services to help achieve their goals and meet basic needs.
• Documents each client encounter within the electronic medical record.
• Maintains adherence to the documentation timelines of WCKY and all associated oversight bodies or agencies.
• Maintain consistent contact with clients, as defined by agency and department of Medicaid services standards.
• Educates and refers potential program participants to applicable services both internal and external.
• Completes screenings and assessments of potential program participants.
• Travel between, WCKY program’s connecting with new and transitioning clients in order to connect them with services.
• Input data into the EMR including demographics, insurance information, authorization information, treatment plans, treatment plan reviews, case notes for each encounter, assessments, and follow up appointments.
• Produces reports for the Program Director and Operations Manager as needed;
• Provides feedback to the Program Director and the Operations Manager regarding attainment of goals and objective as well as data collection;
• Assists area and programmatic leadership in Performance Improvement activities;
• Assists other WestCare staff as needed to promote cooperation and portray a professional image to the community;
• Embraces and embodies the mission, vision, guiding principles, clinical vision and goals of WestCare Foundation;
• Performs any other duties as assigned.

Certifications/Licensures

• Bachelors degree in Human services, Social Work or a related field is required. Current Targeted Case Management certification Required.
• Valid driver's license and the ability to obtain and maintain WestCare's vehicle insurance is required.

Education

• Graduation from an accredited four-year college with a degree in Human Services, Social Work, Psychology, or related focus area required;
• High School Diploma or equivalent is required.

Experience and Competencies

• At least one (1) year of experience in a comparable role is required;
• Proficiency in Microsoft Word, Excel, Outlook, and Office required;
• Familiarity with and knowledge of area resources required;
• Basic understanding of appropriate documentation required;
• Ability to work with multi-disciplinary teams required;
• Ability to organize, handle multiple responsibilities, and prioritize appropriately;
• Ability to communicate accurately and responsibly with internal and external teams;
• Ability to work collaboratively with others in a manner that is pleasant and professional;
• Ability to work well, both individually and as part of a team;
• Excellent verbal and written communication skills

Working Conditions

• Work is primarily performed in an office, indoor, or shelter setting;
• Reasonable operational assistance to the hosting location will be required
• Some outdoor activities and travel between multiple locations will be required;
• Regular and prompt attendance is required throughout employment.

Essential Physical and Mental Demands of the Job

The employee must be able to perform the following essential duties and activities with or without accommodation:

Physical Demands

• Requires mobility and physical activity: Having an adequate range of body motion and mobility to work in an office, residential, or outdoor environment including standing and walking (even and uneven surfaces), sitting for extended periods of time, bending, twisting, reaching, balancing, occasional lifting and carrying of up to 50 pounds. Use of computer and telephone systems is required which includes coordination of eye and hand, and fine manipulation by the hands (typing, writing, and working with files).
• Requires the ability to defend oneself and clients in physically abusive situations through the use of approved physical de-escalation techniques.
• Requires talking: Expressing or exchanging ideas by means of the spoken word. Talking is required to impart oral information to employees, clients, patients, and the public, and in those activities in which the employee is required to convey detailed or important spoken instructions to others accurately, loudly, or quickly.
• Requires hearing: Hearing is required to receive and communicate detailed information through oral communication.
• Requires seeing: Clarity of vision at 20 inches or less and at distance. This factor is required to complete paperwork for many of the employee's essential job functions and to observe client behavior and activities in and out of the facility.
• The normal work routine involves no exposure to human blood, body fluids or tissues. However, exposure or potential exposure may be required as a condition of employment. Appropriate personal protective equipment will be readily available to every employee.

Mental Demands

• Requires the ability to track and properly code client encounters to meet payor requirements.
• Requires the ability to work and cooperate with clients, co-workers, managers, the public and employees at all levels in order to exchange ideas, information, instructions and opinions.
• Requires the ability to work under stress and in emotionally charged settings.
• Requires the ability to defend oneself and clients in mentally/verbally abusive situations through the use of approved mental/verbal de-escalation techniques.