Patient Care Advocate

Description of Responsibilities 

The patient care advocate serves as a crucial liaison for ensuring patients have timely access to necessary medications. This position is responsible for efficiently processing prior authorizations and appeals for both pharmacy and medical benefits, working closely with clinics and internal teams. This role requires a strong understanding of medication access processes, excellent communication skills, and a commitment to patient advocacy. 

Reporting Relationship 

Clinical Nurse Coordinator 

Scope of Supervision 

Responsibilities of the Patient Care Advocate include the following: 

1. Complete prior authorization requests on behalf of clinics, ensuring timely and accurate processing along with communicating determination with clinic point of contact. 

1. Prepare and submit appeals for denied prior authorizations, ensuring all necessary documentation is included and deadlines are met. 

1. Address client inquiries and concerns promptly and professionally, providing effective solutions. 

1. Communicate effectively with clients, physicians, and other healthcare providers about medication statuses. 

1. Develop and maintain a strong understanding of the medical information related to the specified medications to effectively complete authorization requests. 

1. Proficiently utilize various electronic health records (EHR) systems, and other software platforms to access patient information and track progress. 

1. Report any misconduct, suspicious or unethical activities to the Compliance Officer. 

1. Represent the pharmacy in a professional and courteous manner in all interactions with patients and clinicians. 

1. Ensure compliance with all licensure and federal, state, and local laws and regulations; observe the pharmacy’s policies on ‘’best practices’’.  

1. Assist in resolving patient concerns and complaints. 

1. Assume on-call responsibilities in accordance with pharmacy guidelines. 

1. Report product incidents as required in accordance with pharmacy policy. 

1. Participate in surveys conducted by authorized inspection agencies.  

1. Participate in the pharmacy’s Performance Improvement program as requested by the Performance Improvement Coordinator.  

1. Participate in pharmacy committees when requested. 

1. Participate in in-service education programs provided by the pharmacy.  

1. Pursue continuing education programs appropriate to job responsibilities and certification requirements.  

The following functions require the professional judgment of a pharmacist and may not be performed by a pharmacy technician: 

1. Acceptance of verbal prescriptions. 

1. Certification of filled prescriptions. 

1. Weighing or measuring active drug ingredients without verification by a pharmacist. 

1. Reconstitution of prefabricated medication without verification by a pharmacist. 

1. Entry of orders into the computer system without verification by pharmacist. 

Minimum Qualifications 

1. Organizational skills sufficient to maintain consistently accurate records. 

1. Ability to evaluate options and to make efficient decisions. 

1. Current knowledge of all applicable state and federal pharmacy laws, rules, and regulations. 

1. Computer skills that include proficiency with spreadsheets and use of the internet, as well as word processing, and efficient use of the internet and e-mail.  

Physical Requirements 

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions in this job description:  

1. The employee is regularly required to stand, walk, and sit, as well as talk and hear. 

1. The employee is required to use hands to operate vehicles and office equipment. 

1. The employee must occasionally lift and/or move up to 30 pounds. 

1. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, and the ability to adjust focus. 

Salary : $22 - $28