Clinical Programs Specialist

The posting, as Judi Health wrote it

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 Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single,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 .

Position Summary

The Clinical Programs Specialist provides operational and administrative support for the day-to-day management of clinical programs and clinical vendor partnerships under the direction of the Clinical Programs Specialists Manager. This role coordinates program reporting, vendor invoices, and drug list maintenance. This role also maintains program workflows and documentation, supports program implementations, monitors recurring deliverables, supports stakeholder communications, and tracks issues through resolution. The Specialist helps ensure established program processes are executed consistently, accurately, and in accordance with contractual, regulatory, and organizational requirements. This role helps ensure programs are executed effectively and efficiently; stakeholders remain informed, and both clients and members receive timely, high-quality support involving clinical programs involving clinical vendor partners.

Position Responsibilities

Vendor Clinical Program Administration

• Supports administration and operational activities for assigned clinical programs involving clinical vendor partners.
• Supports the maintenance of program workflows, standard operating procedures, job aids, process maps, reference materials, and other operational documentation.
• Monitor shared inboxes, work queues, pending activities, recurring deliverables, and escalations to support timely follow-up and continuity of program operations.
• Document vendor program activities, decisions, issues, interventions, and follow-up actions in applicable systems and tracking tools.

Program Coordination & Workflow Management

• Apply established workflows and assist with updates when processes, systems, client requirements, or regulatory guidance change.
• Identify and support resolution of workflow gaps, document operational risks, and escalate recommendations to the Clinical Partnerships Lead.
• Balance multiple work-streams, prioritize time-sensitive activities, and meet established deadlines with minimal oversight.
• Maintain clinical program resources, including drug l

[…]
ors, maintaining service-level or performance tracking, and supporting project implementations.

• Experience working within a Medicare Advantage, Medicaid, Commercial health plan, managed care organization, TPA, PBM, or value-based care environment.
• Knowledge of HEDIS, Medicare Stars, CAHPS, CMS requirements, NCQA standards, or other health plan quality programs.
• Experience administering or coordinating clinical, quality, care management, case management, utilization management, and/or population health program processes
• Experience in business analysis and project management.
• Experience working with medical and pharmacy claims
• Experience with Confluence, Jira, Tableau, Salesforce
• Highly detail-oriented and analytical; bilingual Spanish preferred

This range represents the low and high end of the anticipated base salary range. The actual base salary will depend on several factors such as: experience, knowledge, skills, and location of the job.

Remote, US Salary Range
$65,000 — $75,000 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 at https://www.judi.health/legal/privacy-policy .