Benefits Navigator for CTC

VCU Health • Richmond, VA

11h

About The Position

As a Benefit Navigator, this role will be essential in guiding our members to effectively utilize their VCU Health benefits, ensuring they understand and navigate their policies, especially during complex health situations. You will conduct assessments, liaise between healthcare providers and the Center for Team Care and VCU Health System team, and ensure adherence to HIPAA and other relevant protocols. In addition, you will facilitate team meetings, maintain comprehensive documentation, and actively participate in quality improvement initiatives for the Center for Team Care team Essential Job Statements Provide members with education on effectively utilizing their VCU Health benefits in accordance with their specific policy . Help members navigate their benefits when confronted with complicated health situations, aligning with the care and treatment recommended by their healthcare provider . Develop strategies, maintain comprehensive documentation of member interactions, and generate reports for the purpose of tracking progress and facilitating future reviews . Facilitate team meetings and actively engages in ad hoc meetings when . Sustain an interactive relationship with the members and/or their HIPAA authorized representative (POA), by providing ongoing support for their healthcare needs . Actively engage in quality assessment and process improvement initiatives . Establish and maintain a collaborative relationship with the care navigation team to review case history and/or claims and engage in discussions regarding the subsequent steps and supportive interventions based on the VCU Health policy . Represent Center for Team Care at benefit fairs and other team member resource initiatives . Patient Populatio n: N/A

Requirements

• 3+ years of experience in health benefits education or similar roles, specifically working with patients and family members to understand the benefits available to them.
• Familiarity with HIPAA regulations and the process for claims resolution.
• A history of assisting clients or members in navigating complex health or insurance situations
• Prior work in a collaborative team environment, especially in reviewing plan documents or insurance claims
• Ability to build and maintain strong client relationships, especially in sensitive or difficult scenarios
• Proven leadership or facilitation skills, especially in conducting team meetings
• Experience in outreach or liaison roles, coordinating between clients and external entities like healthcare providers
• Strong documentation skills, with experience in maintaining records of client or member interactions
• Experience in generating and analyzing reports to track progress and aid future reviews

Nice To Haves

• Background in case management, social work, process improvement, or similar experience within the healthcare space
• Combination of education and experience may be considered in lieu of a degree.

Responsibilities

• Provide members with education on effectively utilizing their VCU Health benefits in accordance with their specific policy
• Help members navigate their benefits when confronted with complicated health situations, aligning with the care and treatment recommended by their healthcare provider
• Develop strategies, maintain comprehensive documentation of member interactions, and generate reports for the purpose of tracking progress and facilitating future reviews
• Facilitate team meetings and actively engages in ad hoc meetings when
• Sustain an interactive relationship with the members and/or their HIPAA authorized representative (POA), by providing ongoing support for their healthcare needs
• Actively engage in quality assessment and process improvement initiatives
• Establish and maintain a collaborative relationship with the care navigation team to review case history and/or claims and engage in discussions regarding the subsequent steps and supportive interventions based on the VCU Health policy
• Represent Center for Team Care at benefit fairs and other team member resource initiatives

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees