Patient Care

• Serve as a subject matter expert on pharmacy and medical benefit structures for Medicare, Medicaid, and commercial payers
• Interpret coverage and resolve complex benefit questions
• Provide guidance across prior authorization and appeals processes for prescription medications
• Assess eligibility for copay and financial assistance and connect patients with third-party assistance
• Interpret PBM regulations, policies, and industry developments
• Assess benefit, coverage, and authorization questions and determine resolution strategies
• Own cases end to end, resolving issues and escalating when warranted
• Counsel members and patients on coverage, benefits, and financial assistance options
• Partner with members, providers, pharmacies, and other stakeholders to remove barriers to care
• Analyze claims against benefit guidelines and determine corrective action
• Conduct benefit verification and test claims
• Maintain accurate case documentation and decision rationales
• Evaluate quality, identify trends, and recommend process improvements

Patient Care jobs in Minnesota

Patient Care Advocate