Clinical Programs Manager

Judi Health, LLC; New York (NY); Hybrid; USD 125,000 - 145,000; Full time

Job summary

Judi Health is a health technology company delivering Unified Claims Processing™ for pharmacy and medical benefits. We are building an intelligence platform to power benefits plans for millions of Americans, with a hybrid work model in local NYC, Charlotte, or Denver areas.

The Clinical Programs Manager develops and optimizes clinical programs for pharmacy and medical benefits, overseeing lifecycle, value delivery, and outcomes while collaborating with analytics, product, finance, marketing,

Qualifications

• Active, unrestricted PharmD or RN license in your state of residence.
• 2+ years in health plan/PBM/managed care and/or clinical program management.
• Excellent communication and organizational skills.
• Ability to work independently in a hybrid, fast-paced environment.
• Experience with clinical analytics, reporting, and large data sets.
• Experience with cross-functional program implementation.

Responsibilities

• Develop, implement, and maintain clinical programs across lines of business.
• Collaborate with cross-functional teams to plan and launch programs.
• Maintain clinical resources: drug lists, SOPs, training materials.
• Provide pharmacist expertise for workflows and clinical decision-making.
• Oversee third-party vendors for disease management programs.
• Support go-to-market strategies including pricing and implementation.
• Monitor program performance and reporting; communicate with stakeholders.
• Mentor staff and serve as a preceptor as needed.

Skills

Excellent communication

Organizational skills

Independent work

Detail-oriented

Clinical analytics

Team collaboration

Hybrid work adaptation

Education

PharmD or RN license

Tools

Confluence

Jira

Tableau

Salesforce

Job description

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 Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single,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.
• 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 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 hiringprocess or thereafter. Any information that you do provide will be recorded and maintained in aconfidential 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 measurethe effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Classification of protected categoriesis 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.