Clinical Programs Specialist

Judi Health, LLC; Charlotte, Denver, New York (NC, CO, NY); Remote; USD 65,000 - 75,000; Full time

Job summary

Judi Health, LLC is seeking a Clinical Programs Specialist to provide operational and administrative support for clinical programs and vendor partnerships under the Clinical Programs Specialists Manager. You will handle program reporting, vendor invoicing, drug list maintenance, and documentation, ensuring processes align with contractual, regulatory, and organizational requirements.

Responsibilities include updating workflows, monitoring deliverables, and maintaining resources such as drug

Qualifications

• Active, unrestricted pharmacy license or equivalent healthcare license.
• 1+ years of experience in health plan, managed care, PBM, or related clinical operations.
• Experience supporting clinical program processes and stakeholder coordination.
• Ability to balance multiple complex projects with minimal direction.
• Strong oral and written communication; organizational skills.
• Designated secure workspace and compliant remote connectivity.

Responsibilities

• Support administrative and operational activities for assigned clinical programs and vendor partners.
• Maintain program workflows, SOPs, job aids, process maps, and reference materials.
• Monitor shared inboxes, queues, and recurring deliverables to ensure timely follow-up.
• Document vendor program activities and decisions in applicable systems.

Skills

Spanish (preferred)

Stakeholder coordination

Multi-project management

Strong communication

Remote-work readiness

Education

Pharmacy or healthcare license (unrestricted)

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 Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single,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

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

• 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 elevate 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 lists, through routine reviews, scheduled updates, and ad hoc changes.

Clinical Vendor & Stakeholder Support

• Support the monitoring of vendor service-level commitments, reporting schedules, and required deliverables; elevate delays or performance concerns.
• Coordinate resolution of program inquiries and escalations while promoting a positive stakeholder and member experience.
• Support operations including vendor invoicing and reporting, custom client implementation requests, reporting requirements, claims monitoring, issue resolution, member communication proofs, and ongoing vendor program maintenance.
• Collaborate with internal and external stakeholders to ensure effective communication, coordination, a satisfactory client experience, and continuity of member care.
• Support the Clinical Programs Business Development needs, including client contracting, vendor management, preparation of opportunity analyses, and program sales support.

Quality, Compliance & Operational Excellence

• 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.
• Uphold general business needs and operations as required

Required Qualifications

• Active, unrestricted pharmacy technician license, licensed practical nurse (LPN), certified medical assistant (CMA), or equivalent license in healthcare administration, public health, or health sciences.
• 1+ years of applicable experience in a health plan, managed care organization, PBM, TPA, case management, utilization management, quality, population health, clinical operations, or related healthcare environment.
• Experience supporting established clinical program processes, operational workflows, implementations, or stakeholder coordination.
• Ability to balance multiple complex projects simultaneously with minimal direction
• Strong oral, written, interpersonal, problem-solving, facilitation, and organizational skills.
• Have a designated workspace (an office, spare bedroom, etc.) that is visibly secure from others during work hours (closed door) and is protected from noise that could disrupt conversations
• Have required internet connectivity consistent with company remote-work standards.

Preferred Qualifications

• Experience supporting clinical vendors, 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 .

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.