Patient Navigator

Caremetx-LL; United States; Remote; USD 65.000 - 85.000; Vollzeit

Zusammenfassung

CareMetx is seeking a Patient Navigator to work from a home-based office, supporting patients and caregivers in accessing therapy and managing reimbursement options. You will coordinate with Hub staff, Specialty Pharmacy, and Market Access to secure coverage and approvals.

The role requires a minimum of 5 years in reimbursement, strong communication skills, and the ability to manage a regional case load. Bilingual Spanish is preferred; travel may be required for onboarding and occasional

Qualifikationen

• Bachelor’s Degree in business, health sciences, public policy, or related fields preferred.
• Minimum 5 years of reimbursement experience (benefits investigation, prior authorization, medical benefit, Medicaid).
• Bilingual with fluency in Spanish is preferred.

Aufgaben

• Serve as single point of contact for providers, patients, and sales teams.
• Assist patients and caregivers in gaining access to therapy and navigating reimbursement options.
• Coordinate with Specialty Pharmacy and Hub to obtain coverage and approval.
• Provide information on reimbursement options and financial assistance to patients.
• Maintain patient case load and regular follow-up interactions.
• Document case history in the CRM system and ensure data integrity.
• Resolve ongoing reimbursement issues related to insurance changes and PA processes.
• Collaborate with Field Sales Reps and Market Access teams.
• Answer patient inquiries and troubleshoot access/reimbursement problems.
• Work remotely with a dedicated home office and attend in-person onboarding for 3 days.

Kenntnisse

Active listening

Written communication

Analytical skills

Leadership

Interpersonal skills

Ausbildung

Bachelor’s Degree

Tools

Word/Excel/PowerPoint

CRM system

Jobbeschreibung

Under the general direction of Operations Management, the Patient Navigator will work closely with patients, and caregivers to help patients gain access to therapy and to help ensure ongoing compliance with therapy, The contact center is a Pharmaceutical Hub Service Center assisting patients with gaining access to available medicines and medical treatments. Services provided by the Hub staff include benefit coverage investigation, prior authorization requirements analysis, product delivery and non-clinical case management. Bilingual English/Spanish is preferred.

PRIMARY DUTIES AND RESPONSIBILITIES:

• Acts as a single point of contact and voice for all providers, patients and product/sales team.
• Works closely with patients and caregivers and help patient gain access to therapy
• Work with Specialty Pharmacy and Hub to help obtain reimbursement coverage
• Provide information to patients/caregivers on reimbursement options and financial assistance options
• Coordinates access to therapies, conducts appropriate follow up and facilitates access to appropriate support services.
• Manages a regional case load.
• Responsible for maintaining case history for all assigned patients in the CRM system
• Help to resolve ongoing reimbursement issues (insurance changes, PA’s, other)
• Work with Field Sales Reps and Market Access team
• Answer patient inquiries, as appropriate, and help resolve patient problems related to access and reimbursement
• Provide ongoing support by making regular calls with the patients and caregivers
• Provide assistance with patient access requests and the application process
• Maintain regular and reliable attendance, including being present, on time, and prepared for work as scheduled.
• Performs other related duties as assigned.

Qualifications

EXPERIENCE AND EDUCATIONAL REQUIREMENTS:

• Bachelor’s Degree (general business, health sciences, public policy, or other related degrees) preferred
• Minimum 5 years of Reimbursement experience (benefits investigation, prior authorization, medical benefit, Medicaid experience)
• Preferred: Bilingual with fluency in Spanish

MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS:

• Exceptional listening, written and analytical skills.
• Proficient in Word, Excel, and PowerPoint for presentation and report development.
• Strong knowledge of customer care processes and techniques.
• Excellent leadership, communication, and interpersonal skills.
• Flexible, detailed, and able to successfully adapt to change.
• Complies with all laws, regulations, and policies that govern CareMetx activities related to the contact center.
• Proven track record of meeting or exceeding goals and objectives.
• Work from home position, requires a dedicated office space that is quiet and free from distractions
• Must be able to attend in person onboarding training for 3 days (i.e. product training etc.)

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to sit.
• The employee must occasionally lift and/or move up to 10 pounds.

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

Schedule:

• Must be flexible on schedule and hours.
• Some Travel may be required.

CareMetx considers equivalent combinations of experience and education for most jobs. All candidates who believe they possess equivalent experience and education are encouraged to apply.

At CareMetx we work hard, we believe in what we do, and we want to be a company that does right by our employees. Our niche industry is an integral player in getting specialty products and devices to the patients who need them by managing reimbursements for those products, identifying alternative funding when insurers do not pay, and providing clinical services.

CareMetx is an equal employment opportunity employer. All qualified applicants will receive consideration for employment and will not be discriminated against based on race, color, sex, sexual orientation, gender identity, religion, disability, age, genetic information, veteran status, ancestry, or national or ethnic origin.

Artificial Intelligence in Our Recruiting and Employment Process

CareMetx uses artificial intelligence and automated decision‑making technology to support parts of our recruiting, hiring, and employment process, including screening applications, scheduling interviews, and evaluating candidate qualifications. These tools support, not replace, human judgment. A qualified member of our team reviews and makes all final hiring and employment decisions.

CareMetx does not develop or use AI tools with the intent to discriminate against applicants or employees on the basis of race, color, religion, sex, age, sexual orientation, national origin, disability, veteran status, or any other protected characteristic.