[Hiring] Patient Care Advocate @AffirmedRx

Role Description

The Patient Care Advocate serves as a trusted liaison between patients and healthcare providers, applying deep expertise in pharmacy benefits to ensure members receive the highest level of care and support. Exercising independent judgment, the PCA advocates for each patient's needs, provides education and guidance, and resolves the complexities of the pharmacy benefit so members can navigate the healthcare system with confidence. The role calls for sound decision-making, strong communication and interpersonal skills, and the ability to collaborate effectively with internal and external stakeholders to drive issues through to resolution.

What you will do:

• Knowledge and Expertise:
  • Serve as a subject matter expert on the pharmacy and medical benefit structures of all major payer types — Medicare, Medicaid, and commercial.
  • Provide authoritative guidance across the full prior authorization and appeals process for prescription medications.
  • Assess patient eligibility for copay and financial assistance from public, private, and non-profit sources.
  • Interpret PBM regulations, policies, and industry developments to advise patients and inform decisions.
• Engagement and Collaboration:
  • Independently assess complex benefit, coverage, and authorization questions from members and providers.
  • Own cases end to end, exercising discretion to resolve issues and escalating only when circumstances warrant.
  • Counsel members and patients on coverage, benefits, and financial assistance options.
  • Partner with internal and external stakeholders to coordinate community-based resources to remove barriers to care.
• Analysis and Quality:
  • Analyze claims against benefit guidelines, identifying discrepancies and determining appropriate corrective action.
  • Conduct benefit verification and test claims to validate coverage and inform resolution.
  • Maintain thorough, accurate documentation of case activity and the rationale behind decisions.
  • Evaluate quality and identify trends across interactions and documentation, and recommend process improvements.

Qualifications

• Must live in Minnesota and be willing to travel within the state.
• Bachelor's degree in a healthcare-related field (preferred) 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 appeals, healthcare regulations, and payer/insurance processes.
• Excellent communication and interpersonal skills.
• Strong analytical and problem-solving skills.
• A patient-centered approach, with the empathy to support members through difficult or high-stakes situations.
• Proficiency with claims, benefit verification, and case management systems.
• Strong organizational skills and attention to detail.
• Ability to work both independently and collaboratively with internal and external stakeholders.
• Commitment to maintaining patient confidentiality and adhering to ethical and regulatory standards.
• A private, quiet workspace for remote work.

Benefits

• To impact industry change in the pharmacy benefits management space, while delivering the highest quality patient outcomes.
• To work in a culture where people thrive because when OUR team thrives, OUR business thrives.
• Competitive compensation, including health, dental, vision and other benefits.