Judi Health

Unified claims processing for health benefits

Clinical Programs Manager

Medical, Clinical & VeterinaryConfirmed live in the last 24 hours

Full-time$125k - $145k

About the Job

Requirements

An active, unrestricted PharmD or RN license in the state of residence is required.
At least 2 years of prior health plan, pharmacy benefit management, managed care, and/or clinical program management experience, or completion of a PGY1 Managed Care Pharmacy Residency Program or fellowship, is required.
Strong oral and written communication and organizational skills are required.
Ability to work independently with minimal supervision and remain productive in a hybrid, fast-paced environment is required.
Ability to handle multiple competing priorities in a dynamic environment and collaborate with a team is required.
Experience with clinical analytics, reporting, and/or large data sets is required.

Responsibilities

Collaborate with stakeholders to develop, implement, and maintain clinical programs across lines of business, including drug utilization review, opioid management, adherence, pharmacogenomics, disease management, and other clinical initiatives.
Partner with cross-functional teams on clinical program planning, implementation, execution, and ongoing management.
Maintain and update clinical program resources, including drug lists, clinical rules, job aids, call scripts, standard operating procedures, training materials, and related documentation.
Provide pharmacist expertise for program workflows, outreach strategies, prescriber communications, and clinical decision-making.
Own relationships with and oversee third-party vendors administering clinical programs, with emphasis on disease management.
Support go-to-market strategies for clinical products, including pricing, marketing, and implementation.
Support requests for information and requests for proposals submissions.
Partner with internal and external stakeholders on program launches, workflow enhancements, reporting initiatives, client implementations, and clinical projects.
Monitor program performance, claims activity, and reporting requirements, while ensuring effective stakeholder communication.
Identify operational trends and recommend process improvements to enhance quality, efficiency, member outcomes, and program effectiveness.
Support manager and department initiatives through special projects, operational support, and cross-functional collaboration.
Assist with staff training, onboarding, and development activities as needed.
Serve as a preceptor for student pharmacists and residents as required.
Maintain compliance with applicable federal, state, local, and organizational regulations, policies, and guidelines.
Adhere to HIPAA requirements, internal standard operating procedures, and company policies in daily responsibilities.
Remain current on organizational communications, clinical updates, and process changes and apply them to daily work.

Desired Qualifications

Experience in clinical program management, quality improvement, population health management, and/or cost savings initiatives.
Experience managing medication lists.
Experience supporting cross-functional program implementation and workflow optimization.
Experience with Confluence, Jira, Tableau, and Salesforce.
Experience with Medicare, Medicaid, and Commercial/Exchange lines of business.
Experience with PQA, Star, and HEDIS measures.

About Judi Health

Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single, secure platform. By delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels.

At Judi Health, we're deploying the infrastructure our country needs to deliver the healthcare we all deserve. We are the intelligence platform powering benefits plans for millions of Americans and proudly leading the next generation of care. To learn more, visit www.judi.health.

Location: Hybrid (Local to Charlotte, Denver or NYC area)

Position Summary:

The clinical programs manager is responsible for applying their clinical knowledge and expertise to develop and optimize clinical programs for both pharmacy and medical benefit clients. The role oversees the lifecycle of clinical and cost savings programs, ensures programs deliver value, meet quality and operational standards, and achieve clinical and/or financial outcomes for clients. The clinical programs manager collaborates with both internal and external stakeholders to develop and maintain clinical programs, such as analytics, product, finance, marketing, client services, sales, operations, and vendors.

Position Responsibilities:

Program Development, Implementation & Maintenance

Collaborate with stakeholders to develop, implement, and maintain clinical programs across all lines of business, including but not limited to drug utilization review, opioid management, adherence, pharmacogenomics, disease management, and other clinical initiatives.
Partner with cross-functional teams to ensure successful program planning, implementation, execution, and ongoing management.
Maintain and update clinical program resources, including drug lists, clinical rules, job aids, call scripts, SOPs, training materials, and related documentation.
Provide pharmacist expertise for program workflows, outreach strategies, prescriber communications, and clinical decision-making.
Own relationship with and provide oversight of third-party vendors to administer clinical programs with emphasis on disease management.
Support the go-to-market strategy of clinical products including pricing, marketing, and implementation.
Support RFI and RFP submissions.

Collaboration, Reporting & Continuous Improvement

Partner with internal and external stakeholders to support program launches, workflow enhancements, reporting initiatives, client implementations, and clinical projects.
Monitor program performance, claims activity, and reporting requirements while ensuring effective communication among stakeholders.
Identify operational trends and recommend process improvements that enhance quality, efficiency, member outcomes, and program effectiveness.
Support manager and department initiatives through special projects, operational support, and cross-functional collaboration.
Assist with staff training, onboarding, and development activities as needed.
Serve as preceptor for student pharmacists and residents as required.

Compliance & Professional Standards

Maintain compliance with all applicable federal, state, local, and organizational regulations, policies, and guidelines.
Adhere to HIPAA requirements, internal SOPs, and company policies in the performance of daily responsibilities.
Remain current on organizational communications, clinical updates, and process changes and apply them appropriately to daily work activities.

Required Qualifications:

Active, unrestricted PharmD or RN license in your state of residence
2+ years of prior health plan/PBM/managed care and/or clinical program management experience and/or completion of a PGY1 Managed Care Pharmacy Residency Program or fellowship required
Excellent communication (oral and written) and organizational skills
Ability to work independently with minimal supervision, stay productive in a hybrid, fast paced environment
Self-motivated and detail-oriented problem solver
Ability to handle multiple competing priorities in a dynamic environment and collaborate in a team
Experience with clinical analytics, reporting, and/or working with large data sets

Preferred Qualifications:

Clinical program management, quality improvement, population health management, and/or cost savings initiative experience
Experience managing medication lists
Experience supporting cross-functional program implementation and workflow optimization
Experience with Confluence, Jira, Tableau, Salesforce
Experience with all lines of business (Medicare, Medicaid, Commercial/Exchange)
Experience with PQA/Star/HEDIS measures

New York, NY Salary Range

$125,000—$145,000 USD

Denver, CO Salary Range

$125,000—$145,000 USD

Charlotte, NC Salary Range

$125,000—$145,000 USD

All employees are responsible for adherence to the Judi Health Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.

We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found athttps://www.judi.health/legal/privacy-policy.

New York, NY Salary Range 125000 - 145000 USD
Denver, CO Salary Range 125000 - 145000 USD
Charlotte, NC Salary Range 125000 - 145000 USD

About the Company

Judi Health

Unified claims processing for health benefits

Judi Health is a New York health tech and benefits administrator serving employers, unions, health plans, and government entities, with three brands: Judi Rx, a transparent pass-through PBM; Judi Care, which handles medical, dental, and vision benefits and care navigation; and Judi Cloud, which licenses the platform to health plans and TPAs. Its core product is the Judi platform, a Unified Claims Processing system that brings pharmacy and medical claims onto a single cloud with AI-enabled workflows to adjudicate benefits. The company differentiates itself with price transparency through flat fees and a single, unified platform that reduces fragmentation, pursuing growth without acquisitions. Its goal is to simplify and lower the cost of health benefits administration and scale across commercial, Medicare, and Medicaid by licensing the platform and offering care services.

Company size: 501-1,000
Company stage: Series F
Total funding: $585M
Headquarters: New York City, New York
Founded: 2017

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