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Clinical Programs Administration Specialist (temp-to-hire)
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What you'll do
- Triage clinical program calls, schedule consultations, and conduct outreach to members, prescribers, and pharmacies.
- Support the administration and execution of clinical programs- including cost-containment initiatives and other clinical services.
- Provide compassionate, professional support to members and providers while promoting a positive customer experience.
- Document outreach, case activities, interventions, and follow-up actions in applicable systems.
- Monitor outreach queues, pending activities, and escalations to support timely completion of clinical programs and continuity of care.
- Identify, document, and escalate issues requiring resolution to support quality outcomes and operational effectiveness.
- Support general business operations and other duties as assigned.
- Collaborate with internal and external stakeholders to ensure effective communication, coordination, and continuity of care.
- 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.
What they're looking for
- Active, unrestricted pharmacy technician license
- 1+ years of applicable experience in a clinical pharmacy setting, PBM, health plan, or related health care setting
- 1+ year of customer service experience with a passion for building customer loyalty through exceptional listening, relationship building, and strong written and verbal communication
- 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 the following internet connectivity: DSL, cable modem or fiber with a wired connection to device (wi-fi not allowed). Internet speed of one gigabyte (940bps) is required
Nice to have
- Cost containment experience
- Proficient in Microsoft Office Suite with emphasis on Microsoft Excel and PowerPoint
- Experience with Confluence, Jira, Tableau, Salesforce
- Highly detail-oriented and analytical
- Bilingual- Spanish preferred
- Experience working with pharmacy claims
Summarised by NextRaise from the employer’s description, which follows in full below.
Full description from employer
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 Administration Specialist (temp-to-hire: 6-month contract with possibility of extending or converting to full time, depending on business needs) is responsible for supporting clinical program operations by triaging inbound calls and conducting member, prescriber, and pharmacy outreach activities. This role plays a key part in ensuring seamless program execution and an exceptional member experience.
Position Responsibilities:
Clinical Programs Administration
- Triage clinical program calls, schedule consultations, and conduct outreach to members, prescribers, and pharmacies.
- Support the administration and execution of clinical programs- including cost-containment initiatives and other clinical services.
- Provide compassionate, professional support to members and providers while promoting a positive customer experience.
- Document outreach, case activities, interventions, and follow-up actions in applicable systems.
Program Coordination & Workflow Management
- Monitor outreach queues, pending activities, and escalations to support timely completion of clinical programs and continuity of care.
- Identify, document, and escalate issues requiring resolution to support quality outcomes and operational effectiveness.
- Support general business operations and other duties as assigned.
Collaboration & Stakeholder Engagement
- Collaborate with internal and external stakeholders to ensure effective communication, coordination, and continuity of care.
Compliance & Regulatory Requirements
- 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.
Minimum Qualifications:
- Active, unrestricted pharmacy technician license
- 1+ years of applicable experience in a clinical pharmacy setting, PBM, health plan, or related health care setting
- 1+ year of customer service experience with a passion for building customer loyalty through exceptional listening, relationship building, and strong written and verbal communication
- 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 the following internet connectivity: DSL, cable modem or fiber with a wired connection to device (wi-fi not allowed). Internet speed of one gigabyte (940bps) is required
Preferred Qualifications:
- Cost containment experience
- Proficient in Microsoft Office Suite with emphasis on Microsoft Excel and PowerPoint
- Experience with Confluence, Jira, Tableau, Salesforce
- Highly detail-oriented and analytical
- Bilingual- Spanish preferred
- Experience working with pharmacy claims
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.
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.
Company
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