Associate Care Navigator

This is a fully remote position, open to applicants in Nebraska.

📋 Description

• Perform case management on behalf of clients and Southern Scripts to oversee specialty drug expenditures and realize savings.

• Identify the most cost-effective drug options while fostering a high-touch, member-focused relationship.

• Deliver tailored, personalized service based on members’ benefits, health data, and engagement levels.

• Facilitate transitions in site-of-service and other RxCompass cost-reduction strategies.

• Communicate with members and providers via telephone, written correspondence, fax, or app.

• Educate and consult with members and providers through customized programs.

• Assist members in comprehending claims, accumulators, usage, balances, and cost sharing.

• Create, propose, and execute member-focused solutions that lower specialty medication expenses.

• Manage referrals within stipulated turnaround times.

• Uphold client expectations regarding efficiency, service levels, privacy, and quality of decisions.

• Ensure compliance with ERISA, HIPAA, and client-specific regulations.

• Collaborate with medical and pharmacy providers, hospitals, members, home infusion providers, and other vendors.

• Report any HIPAA violations to the Compliance Officer and/or Human Resources.

• Collaborate effectively within the team to achieve business-unit goals and adapt to changes.

⛳️ Requirements

• High School diploma; some college education preferred or equivalent experience.

• 1-2 years of experience in member engagement within PBM and medical settings.

• 1-2 years of experience in Specialty Pharmacy or PBM roles.

• 1-2 years of experience using CRM platforms.

• 1-2 years of experience working with Clinical, Prior Authorization, sales, account management, senior executives, and various external client-facing relationships.

• Availability during core working hours of 8:00 AM to 5:00 PM CT.

• Capability to adjust work hours to accommodate meetings across all time zones.

• Willingness to work extended hours, weekends, and holidays as necessary.

• Ability to travel overnight from a remote location.

• Proficient in interacting with a diverse customer base in a friendly manner.

• Possess empathy and effective listening skills.

• Demonstrated experience in medical/pharmacy benefits, particularly concerning specialty medications.

• Ability to maintain a balance of compassion, integrity, discretion, and sound judgment.

• Adherence to HIPAA, ERISA, and client-specific requirements.

• Attendance and successful completion of required HIPAA training with demonstrated competency.

🏝️ Benefits

• Full-time hourly/non-exempt position.

• Some flexibility in working hours.

• Remote work opportunity.

• Equal employment opportunity and protections against discrimination.