Clinical Programs Case Management Specialist

Judi Health, LLC; United States; Remote; USD 65,000 - 70,000; Full time

Job summary

Judi Health, LLC is seeking a Clinical Programs Case Management Specialist for a remote role in the United States. The position supports site-of-care optimization by contacting members, prescribers, and infusion providers to ensure smooth transitions and timely, high-quality support.

The role collaborates with external vendors and internal teams, documenting activities and ensuring program effectiveness, with a focus on compassionate, customer-focused service and adherence to HIPAA and

Qualifications

• Experience in medical case management or healthcare support roles.
• Experience with EMRs and patient workflows.
• Minimum of 3 years in clinical settings or related healthcare environment.
• At least 1 year of customer service experience.

Responsibilities

• Coordinate site-of-care optimization referrals and outreach to members, prescribers, and infusion providers.
• Educate members on infusion therapy options and site-of-care alternatives.
• Manage referrals and provide status updates throughout the referral process.
• Act as liaison between internal teams, providers, and external partners.
• Document outreach attempts, case activities, outcomes, and follow-up actions.

Skills

Case management

Customer service

Communication

EMR systems

Job description

Clinical Programs Case Management Specialist

Remote

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 Judi Health replaces fragmented, outdated systems with the industry’s first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single,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 Case Management Specialist is responsible for supporting Judi Health’s site-of-care optimization program by conducting outreach to members, prescribers, and infusion providers to facilitate a seamless transition of infusion services when appropriate. This role serves as a key liaison with external vendors and internal stakeholders to ensure programs are executed effectively and efficiently, stakeholders remain informed, and members receive timely, high-quality support.

Position Responsibilities:

Clinical Programs Administration

• Own the administrative processes related to Judi Rx’s site-of-care optimization program referrals, including conducting and coordinating outreach to members, prescribers, pharmacies, and other healthcare stakeholders.
• Educate members on infusion therapy options, site-of-care alternatives, benefit considerations, and available support resources to promote informed healthcare decisions.
• Coordinate with members, prescriber offices, patient coordinators, and care navigators to facilitate referrals, support continuity of care, and provide status updates throughout the referral process.
• Serve as a liaison between internal teams, providers, and external partners to address questions, resolve issues, and support timely service delivery.
• Deliver compassionate, professional, and customer-focused support while maintaining a positive member and provider experience.
• Accurately document outreach attempts, case activities, interventions, outcomes, and follow-up actions in applicable systems.

Program Coordination & Case Management

• Manage assigned case workloads, outreach queues, and pending activities to support timely case resolution and continuity of care.
• Track and monitor referral progress, escalations, and program-related activities to ensure adherence to established service levels and workflows.
• Maintain program resources, including drug lists, workflow documentation, and operational materials through routine reviews and updates.
• Identify, document, and elevate issues or barriers impacting member access, provider engagement, or program effectiveness.
• Support departmental initiatives and perform additional duties as assigned.

Collaboration & Stakeholder Engagement

• Partner with clinical, operational, account management, and business teams to support program implementation, execution, and ongoing success.
• Collaborate with internal and external stakeholders to ensure effective communication, care coordination, and issue resolution.
• Support reporting activities, claims monitoring, opportunity analysis, and stakeholder communications related to clinical program performance and outcomes.
• Participate in cross-functional meetings and provide program insights, feedback, and recommendations to support business objectives.

Quality Improvement & Operational Excellence

• Identify trends, workflow inefficiencies, and opportunities for process improvement to enhance program performance, operational efficiency, and member outcomes.
• Contribute to the development and refinement of workflows, job aids, training materials, and standard operating procedures.
• Support quality assurance activities and continuous improvement initiatives designed to strengthen program effectiveness and service delivery.

Compliance & Regulatory Requirements

• Maintain compliance with all applicable federal, state, local, contractual, and organizational requirements.
• Adhere to HIPAA regulations, internal policies, standard operating procedures, and confidentiality requirements in the performance of all responsibilities.
• Remain current on clinical program requirements, regulatory updates, organizational communications, and process changes, applying updates appropriately to daily work activities.
• Demonstrate commitment to ethical business practices, data integrity, and protection of member information.

Minimum Qualifications:

• Experience in medical case management, patient care, or healthcare support roles such as hospital pharmacy technician, CNA, RN, outpatient technician, or similar clinical positions.
• Experience working with electronic medical records (EMRs), patient assistance programs (PAPs), healthcare documentation systems, and prescriber office workflows.
• Minimum of 3 years of experience in a clinical setting, pharmacy benefit management (PBM), health plan, or related healthcare environment.
• At least 1 year of customer service experience with a demonstrated commitment to delivering exceptional service through active listening, relationship building, and effective written and verbal communication.
• Ability to manage multiple priorities and complex projects simultaneously while working independently with minimal supervision.
• Reliable high-speed internet service via DSL, cable, or fiber with a wired connection to the work device (Wi-Fi not permitted). Minimum internet speed of 940 Mbps (1 Gigabit) required.

Preferred Qualifications:

• Proficient in Microsoft Office Suite applications with emphasis on Microsoft Excel and PowerPoint
• Experience with Confluence, Jira, Tableau, Salesforce
• Highly detail-oriented and analytical
• Experience with infusion providers, vendor relations, and site of care initiatives
• Experience working with pharmacy and medical claims and medical billing

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 - $70,000 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.

Voluntary Self-Identification

For government reporting purposes, we ask candidates to respond to the below self-identification survey. Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiring process or thereafter. Any information that you do provide will be recorded and maintained in a confidential file.

As set forth in Judi Health’s Equal Employment Opportunity policy, we do not discriminate on the basis of any protected group status under any applicable law.

If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection. As a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Classification of protected categories is as follows:

A "disabled veteran" is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service‑connected disability.

A "recently separated veteran" means any veteran during the three‑year period beginning on the date of such veteran’s discharge or release from active duty in the U.S. military, ground, naval, or air service.

An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.

An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.