Employee Benefits Navigator

Saint Peters Healthcare System•New Brunswick, NJ

2d•Onsite

About The Position

The Employee Benefits Navigator will: Serve as a primary point of contact for employees and dependents navigating medical care within the health system. Answer questions related to health insurance benefits, coverage, and network access. Assist employees in understanding in-network vs. out-of-network care and associated costs. Conduct proactive telephonic and in-person outreach to promote wellness initiatives, preventive care, and available health resources. Support employees during new diagnoses, emergency care transitions, and ongoing treatment plans. Collaborate with Outpatient service lines on scheduling appointments, referrals, diagnostic testing, and follow-up care. Facilitate timely follow-up for diagnostic services and specialty care. Coordinate with carriers, TPAs, and internal revenue cycle teams to resolve access or coverage issues. Provide wellness education and guidance at on-site New Hire Orientation program. Develop wellness education programs for employees through in-person sessions and webinars. Create communication strategy and materials to enhance the health and wellbeing for employees and their dependents. Promote wellness vendor platform (WellWorks) to encourage employees and their spouses to meet individual health goals and earn prizes. Encourage engagement in disease management, preventive screenings, and wellness programs. Maintain accurate documentation of interactions while adhering to HIPAA and confidentiality requirements. Track common barriers, trends, and outcomes to support continuous improvement. Provide insights to HR and clinical partners regarding employee healthcare utilization challenges. Other duties and ad-hoc projects as assigned.

Requirements

BSN preferred and must be obtained within 3 (three) years from hire date.
Licensed as a Registered Nurse in the State of New Jersey.
Experience working in an integrated health system or hospital-based setting.
Experience in healthcare navigation, care coordination, benefits administration, population health, or patient advocacy.
Working knowledge of health insurance plans, provider networks, healthcare delivery systems and employee wellness programs.
Strong interpersonal, communication, and problem-solving skills.
Ability to manage sensitive information with discretion and professionalism.
Ability to analyze utilization data and identify opportunities for improvement.

Responsibilities

Serve as a primary point of contact for employees and dependents navigating medical care within the health system.
Answer questions related to health insurance benefits, coverage, and network access.
Assist employees in understanding in-network vs. out-of-network care and associated costs.
Conduct proactive telephonic and in-person outreach to promote wellness initiatives, preventive care, and available health resources.
Support employees during new diagnoses, emergency care transitions, and ongoing treatment plans.
Collaborate with Outpatient service lines on scheduling appointments, referrals, diagnostic testing, and follow-up care.
Facilitate timely follow-up for diagnostic services and specialty care.
Coordinate with carriers, TPAs, and internal revenue cycle teams to resolve access or coverage issues.
Provide wellness education and guidance at on-site New Hire Orientation program.
Develop wellness education programs for employees through in-person sessions and webinars.
Create communication strategy and materials to enhance the health and wellbeing for employees and their dependents.
Promote wellness vendor platform (WellWorks) to encourage employees and their spouses to meet individual health goals and earn prizes.
Encourage engagement in disease management, preventive screenings, and wellness programs.
Maintain accurate documentation of interactions while adhering to HIPAA and confidentiality requirements.
Track common barriers, trends, and outcomes to support continuous improvement.
Provide insights to HR and clinical partners regarding employee healthcare utilization challenges.
Other duties and ad-hoc projects as assigned.