Patient Navigator

CareMetx, LLC; United States; Remote; USD 34,000 - 43,000; Full time

Benefits offered by this job

Work from home

Flexible schedule

Job summary

CareMetx seeks a Patient Navigator to guide patients and caregivers through therapy access, coordinating with the Hub, Specialty Pharmacy, and payors to secure coverage and timely delivery.

The role emphasizes reimbursement navigation, patient communication, data entry in CRM, and maintaining compliance. A bachelor’s degree and 5+ years in reimbursement are preferred; bilingual English/Spanish is a plus. This is a remote, work-from-home position with flexible scheduling.

Qualifications

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

Responsibilities

• Acts as a single point of contact for providers, patients and product/sales team.
• Help patients gain access to therapy and coordinate with Hub and Specialty Pharmacy for coverage.
• Provide information on reimbursement options and financial assistance.
• Coordinate access to therapies and follow up with support services.
• Maintain case history for all assigned patients in CRM.
• Resolve ongoing reimbursement issues (insurance changes, PA’s) and support field team.
• Attend in-person onboarding training for 3 days and maintain regular attendance.
• Some travel may be required.

Skills

Excellent communication

Customer care

Analytical skills

Bilingual English/Spanish

Education

Bachelor’s Degree

Job description

Job Title

Patient Navigator

Position Summary

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.

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

• 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.

Work Environment

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

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.

Equal Employment Opportunity

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.

Salary Description

$25-31 per hour