Director, Clinical Solutions Customer Success

Judi Health, LLC; Charlotte, Denver, New York (NC, CO, NY); On-site; USD 121,000 - 151,000; Full time

Job summary

Judi Health seeks a Director of Clinical Solutions Customer Success to lead clinical strategy for their JUDI platform. You will partner with customer operations and product teams to design, implement, and optimize formularies and utilization programs while ensuring regulatory compliance and high customer satisfaction.

The ideal candidate brings Medicaid FFS expertise, formulary leadership, and 5+ years of team leadership, guiding complex migrations and mentoring clinical and CS teams.

Qualifications

• 15+ years of pharmacy benefit, health plan, Medicaid, or PBM experience.
• 10+ years supporting Medicaid pharmacy programs, including Fee-for-Service.
• 5+ years of direct leadership of team members.
• Experience with state Medicaid agencies and regulatory stakeholders.
• Experience with MMIS implementations, CMS certification activities.

Responsibilities

• Serve as the senior clinical lead for software licensing strategic customer relationships.
• Provide guidance on formularies, PBMs, and utilization management programs.
• Lead implementation and migration activities with clinical expertise.
• Advise on Prior Authorization, Step Therapy, and rebate programs.
• Support CMS certification, MMIS integrations, and regulatory compliance.
• Develop documentation, training, and best practices for teams.
• Mentor team members across customer success and clinical operations.

Skills

Pharmacy benefits experience

Medicaid experience

Leadership experience

Regulatory compliance knowledge

Formulary management

CMS & MMIS knowledge

Healthcare analytics

PBM adjudication knowledge

Cross-functional leadership

State Medicaid collaboration

SQL / data analysis

Education

PharmD or Bachelor Degree in Pharmacy

Tools

RxClaim

JUDI

Job description

Director, Clinical Solutions Customer Success

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 Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single,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 Director, Clinical Solutions Customer Success serves as a senior clinical and strategic leader supporting Judi Cloud software licensing customers on the JUDI® platform. This role partners with the customers operations teams, Judi Health’s product teams, and executive stakeholders to design, implement, and optimize formularies, utilization management programs, and clinical benefit strategies while ensuring regulatory compliance and exceptional customer satisfaction.

The ideal candidate has deep expertise in Medicaid Fee-For-Service pharmacy benefits, formulary management, pharmacy claims adjudication, drug utilization review, CMS and MMIS requirements, rebate programs, and state Medicaid operations. This individual will serve as a trusted advisor to software as a service customers, lead complex implementations and migrations, and provide mentorship across clinical and customer success teams. This role is expected to manage individual contributors within 90-120 days of starting the position.

Position Responsibilities:

• Serve as the senior clinical lead for software licensing strategic customer relationships.
• Provide guidance on pharmacy benefit design, formularies, preferred drug lists (PDLs), and utilization management programs.
• Lead Judi Health team members and clients with implementation and migration activities by providing clinical and formulary subject matter expertise, accurate translation of clinical and formulary requirements into JUDI.
• Advise on Prior Authorization, Step Therapy, Quantity Limits, DUR/cDUR, rebate programs, and state-specific Medicaid requirements.
• Support CMS certification, MMIS integrations, NCPDP standards, and regulatory compliance initiatives.
• Partner cross functionally to resolve complex business and system challenges.
• Create and lead presentations and recommendations to customers and executive stakeholders.
• Identify operational risks and drive process improvements to enhance client and member outcomes.
• Develop documentation, training, and best practices supporting programs and internal teams.
• Mentor team members and provide leadership to individual contributors across customer success and clinical operations functions.
• Support business expansion efforts through Medicaid subject matter expertise and solution consulting.

Required Qualifications:

• PharmD or Bachelor Degree in Pharmacy.
• 15+ years of pharmacy benefit, health plan, Medicaid, or PBM experience.
• 10+ years supporting Medicaid pharmacy programs, including Fee-for-Service Medicaid.
• 5+ years of direct leadership of team members.
• Experience working directly with state Medicaid agencies and regulatory stakeholders.
• Demonstrated expertise in formulary management, utilization management, pharmacy claims adjudication, and Medicaid drug rebate programs.
• Experience supporting MMIS implementations, CMS certification activities, and Medicaid compliance requirements.
• Experience with PBM adjudication platforms such as RxClaim, JUDI, or similar systems.
• Strong presentation, relationship management, and leadership skills.
• Experience leading cross-functional teams and complex client initiatives.
• Experience supporting multiple state Medicaid programs preferred.
• Knowledge of 340B, supplemental rebates, and federal Medicaid pharmacy regulations preferred
• SQL, reporting, and healthcare analytics experience, preferred.

New York, NY Salary Range

$144,800 - $181,000 USD

Denver, CO Salary Range

$132,800 - $166,000 USD

Charlotte, NC Salary Range

$120,800 - $151,000 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.