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 Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single,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