Patient Care Advocacy Manager- Remote

AffirmedRx is on a mission to improve health care outcomes by bringing clarity, integrity, and trust to pharmacy benefit management. We are committed to making pharmacy benefits easy to understand, straightforward to access and always in the best interest of employers and the lives they impact. We accomplish this by bringing total clarity to business practices, leading with clinical approaches, and utilizing state-of-the-art technology.

Join us in improving health care outcomes for all! We promise to do what's right, always.

Position Summary:

The Patient Care Advocacy Manager will lead a team of Patient Care Advocates (PCAs), ensuring they provide exceptional service and support to patients and healthcare providers. This role involves overseeing team performance, offering guidance and training, and ensuring efficient resolution of patient and provider inquiries.

In addition to leadership responsibilities, the Patient Care Advocacy Manager will actively engage in patient, pharmacy, and provider interactions, performing the same functions as a Patient Care Advocate. To excel in this role, they will maintain a deep understanding of pharmacy and medical benefits, manage complex cases, and collaborate with internal and external stakeholders to support AffirmedRx's mission.

This position requires a player-coach approach, balancing hands-on patient support with leading and developing a high-performing team.

What you will do:

• Leadership and Management:
• Lead, mentor, and manage a team of Patient Care Advocates, setting performance expectations, conducting regular performance reviews, and providing ongoing support and development
• Develop and implement strategies to improve team performance and patient outcomes
• Conduct regular team meetings to review performance metrics, discuss challenges, and share updates on industry trends and changes
• Knowledge and Expertise:
  
  
  
  

• Maintain a comprehensive understanding of pharmacy and medical benefit structures for various payer types including Medicare, Medicaid, and Commercial
• Oversee the prior authorization and appeals process, ensuring adherence to guidelines and efficient handling of requests
• Remained informed about copay assistance programs and third-party financial assistance opportunities to guide the team in assisting customers effectively
• Remain updated on PBM regulations, policies, and industry trends to provide accurate and relevant information to both team members and patients
• Engagement and Collaboration:
• Act as a point of escalation for complex patient and provider inquiries, offering resolution and support
• Serve as a direct contact for pharmacy benefit information, prior authorization requests, and navigation support across multiple channels (calls, chat, email, etc.)
• As a Patient Care Advocate, support patients by resolving issues and educating them about benefits, coverage, and financial assistance programs
• Collaborate with internal departments, external stakeholders, and community-based resources to enhance patient care and support
• Monitoring and Quality Assurance:
• Review and monitor the accuracy of claims, ensuring they align with benefit guidelines and contract standards
• Conduct quality assurance reviews of team interactions, including calls, chats, and documentation, to identify areas for improvement
• Implement and oversee compliance with operating and productivity standards
• Document interactions and maintain detailed records in accordance with company policies and regulations
  
  

What you need:

• Bachelor's degree in a healthcare-related field (preferred) or equivalent experience
• 5 years' experience in a customer service or patient advocacy role, with a strong background in healthcare settings.
• 3 years' experience in a leadership or management role, with the ability to motivate and guide a team
• Excellent communication, interpersonal, and problem-solving skills, with the ability to navigate complex healthcare systems and relay complex information effectively
• High level of empathy and compassion, with the ability to provide support in challenging situations
• In-depth knowledge of medical terminology, healthcare regulations, and insurance processes
• Proficient in using electronic medical record systems and other relevant software
• Strong organizational skills, attention to detail, and the ability to manage multiple tasks simultaneously
• Ability to maintain patient confidentiality and adhere to ethical standards
• Flexibility to adapt to changing priorities and manage a dynamic workload
  
  

What you get:

• 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 package, including comprehensive health, dental, vision and other benefits.
  
  

Note:

AffirmedRx is committed to providing equal employment opportunities to all employees and applicants for employment. Remote employees are expected to maintain a professional work environment free of distractions to ensure optimal performance and collaboration.