Minnesota Licensed Patient Care Advocate

Job Summary

Serving as a trusted liaison between patients and healthcare providers, the full-time Minnesota Licensed Patient Care Advocate will apply expertise in pharmacy benefits to ensure members receive optimal care and support while working remotely.

Key responsibilities:

• Provide authoritative guidance on prior authorization and appeals processes for prescription medications, resolving complex benefit questions
• Independently assess and resolve coverage and authorization inquiries from members and providers, managing cases end to end
• Analyze claims against benefit guidelines and maintain accurate documentation of case activities and decisions

Required qualifications:

• Bachelor's degree in a healthcare-related field or equivalent experience preferred
• 4+ years of experience in pharmacy benefits, managed care, or patient advocacy in a healthcare or PBM setting
• Strong knowledge of pharmacy and medical benefit structures, prior authorization, and healthcare regulations
• Excellent communication skills, with the ability to convey complex information clearly to members and providers
• Proficiency with claims, benefit verification, and case management systems