Minnesota Patient Care Advocate

Job Summary

Serving as a trusted liaison between patients and healthcare providers, the remote Minnesota Patient Care Advocate will apply expertise in pharmacy benefits to ensure members receive optimal care and support, while managing complex benefit questions and collaborating with various stakeholders.

Key responsibilities

• Provide authoritative guidance on prior authorization and appeals processes for prescription medications, ensuring appropriate resolutions for each case
• Independently assess and resolve complex benefit and coverage questions from members and providers, maintaining case ownership throughout
• Analyze claims against benefit guidelines, identifying discrepancies and recommending process improvements based on quality evaluations

Required qualifications

• Bachelor's degree in a healthcare-related field or equivalent experience
• 4+ years of proven 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, and healthcare regulations
• Proficiency with claims, benefit verification, and case management systems
• Ability to maintain patient confidentiality and adhere to ethical and regulatory standards