Clinical Programs Case Management Specialist

Capital Rx Inc.; USA; Remote; USD 65.000 - 70.000; Vollzeit

Zusammenfassung

Judi Health is seeking a Clinical Programs Case Management Specialist to support site-of-care optimization by engaging members, prescribers, and infusion providers. You will coordinate referrals, educate on infusion options, and ensure timely, high-quality care with internal and external stakeholders.

Responsibilities include documenting activities, tracking referrals, and collaborating across clinical, operational, and account teams to drive program success while maintaining HIPAA compliance.

Qualifikationen

• 3+ years of experience in a clinical setting, PBM, health plan, or related environment.
• At least 1 year of customer service with strong written and verbal communication.
• Experience working with EMRs and healthcare documentation systems.
• Ability to manage multiple priorities and complex projects independently.
• Familiarity with HIPAA, confidentiality, and data integrity requirements.

Aufgaben

• Coordinate outreach to members, prescribers, pharmacies, and other healthcare stakeholders for site-of-care referrals.
• Educate members on infusion therapy options, site-of-care alternatives, and available support resources.
• Coordinate with members, prescribers, patient coordinators, and care navigators to provide referrals and status updates.
• Serve as a liaison between internal teams, providers, and external partners to address questions and ensure timely service delivery.
• Document outreach attempts and case activities in applicable systems; maintain accurate records.
• Track referral progress and escalations to ensure adherence to service levels and workflows.
• Maintain program resources, including drug lists and workflow materials, through routine reviews.
• Identify barriers impacting member access and escalate issues as needed.
• Support departmental initiatives and other duties as assigned.

Kenntnisse

Medical Case Management

EMR Systems

Clinical Experience

Customer Service

Multi-tasking

Reliable Internet

Tools

Microsoft Excel

PowerPoint

Confluence

Jira

Tableau

Salesforce

Jobbeschreibung

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 Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing architecture, seamlessly consolidating pharmacy and medical benefit administration on a single,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


• Bilingual- Spanish preferred


• Experience with infusion proviers, vendor relations, and site of care initiatives


• Experience working with pharmacy and medical claims and medical billing

Remote, US Salary Range

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.

$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 athttps://www.judi.health/legal/privacy-policy.