Minnesota Patient Care Advocate

Job Summary

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

Key responsibilities:

• Provide authoritative guidance on prior authorization and appeals for prescription medications, ensuring appropriate resolutions for complex benefit questions
• Independently assess and resolve coverage and authorization inquiries from members and providers, while counseling patients on financial assistance options
• Analyze claims against benefit guidelines, maintain accurate documentation, and recommend 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 processes, and healthcare regulations
• Excellent communication skills with the ability to simplify complex benefit information for members and providers
• Proficiency with claims, benefit verification, and case management systems