Minnesota Licensed Patient Care Advocate

Job Summary

Serving as a trusted liaison between patients and healthcare providers, the Minnesota Licensed Patient Care Advocate will work remotely to provide expert guidance on pharmacy benefits, resolve complex coverage issues, and ensure patients receive the highest level of care and support.

Key responsibilities:

• Act as a subject matter expert on pharmacy and medical benefit structures, interpreting coverage and resolving complex benefit questions
• Manage the prior authorization and appeals process for prescription medications, providing tailored guidance to patients and healthcare providers
• Analyze claims against benefit guidelines, maintaining accurate documentation and recommending process improvements based on quality evaluations

Required qualifications:

• Bachelor's degree in a healthcare-related field or equivalent experience
• 4+ years of experience in pharmacy benefits, managed care, or patient advocacy within a healthcare or PBM setting
• Strong knowledge of pharmacy and medical benefit structures, prior authorization, appeals, and healthcare regulations
• Proficiency with claims, benefit verification, and case management systems
• Ability to work independently and collaboratively while maintaining patient confidentiality and adhering to ethical standards