Care Advocate - Full Time

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