PCRX Care Navigator

Point C

10d•$70,000 - $80,000

About The Position

Point C is a National third-party administrator (TPA) with local market presence that delivers customized self-funded benefit programs. Our commitment and partnership means thinking beyond the typical solutions in the market – to do more for clients – and take them beyond the standard “Point A to Point B.” We have researched the most effective cost containment strategies and are driving down the cost of plans with innovative solutions such as, network and payment integrity, pharmacy benefits and care management. There are many companies with a mission. We are a mission with a company. The Nurse Care Navigator – Drug Optimization & Pharmacy Coordination is a licensed nurse responsible for coordinating and overseeing case management services related to medication optimization, international drug sourcing, and pharmacy benefit management (PBM) collaboration. This role serves as a clinical liaison among members, PBMs, international sourcing partners, providers, and internal teams to ensure safe, cost effective, and clinically appropriate medication use.

Requirements

Active, unrestricted RN or LPN/LVN license (compact preferred, where applicable)
Nursing degree or diploma from an accredited program
3–5+ years of experience in nursing, case management, care coordination, or a related clinical role
Strong knowledge of pharmacology and medication management
Experience collaborating across multiple stakeholders, including providers, PBMs, and pharmacy partners
Strong clinical judgment within scope of licensure
Excellent communication skills and attention to detail, with a focus on accurate documentation
Ability to coordinate member-focused care across cross-functional teams
Working knowledge of regulatory and compliance requirements

Nice To Haves

Experience in case management, PBMs, specialty pharmacy, or medication access programs preferred
Familiarity with evidence-based guidelines (e.g., MCG, InterQual) preferred
Experience in a TPA, managed care, or employer-sponsored health plan environment preferred

Responsibilities

Coordinate case management activities related to medication optimization, adherence, and therapeutic appropriateness
Review medication regimens and clinical documentation to identify optimization opportunities
Collaborate with providers, PBMs, and pharmacy partners to support evidence-based medication use and access
Support specialty and high-cost medication coordination initiatives
Coordinate international drug sourcing programs, including partner collaboration, member education, and continuity of care
Serve as a clinical liaison across PBMs, pharmacy vendors, and internal teams to align on formulary options and access strategies
Conduct member outreach, education, and follow-up to support adherence and understanding
Review clinical records, pharmacy data, and provider documentation; escalate complex cases as needed
Ensure compliance with nursing scope of practice, regulatory requirements, and organizational policies
Maintain accurate and timely clinical documentation