Clinical Programs Specialist

Judi Health is a health technology company providing benefit administration solutions. The Clinical Programs Specialist supports day-to-day clinical program operations and vendor partnerships, coordinating reporting, invoices, drug-list maintenance, implementations, workflows, and stakeholder communications.

Responsibilities

• Vendor Clinical Program Administration 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 escalate 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; escalate 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

Preferred

• 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
• Clinical Vendor Support
• Service-Level Tracking
• Performance Tracking
• Project Implementation
• Medicare Advantage
• Medicaid
• Commercial Health Plans
• Managed Care
• Third-Party Administration
• Pharmacy Benefit Management
• Value-Based Care
• HEDIS
• Medicare Stars
• CAHPS
• CMS Requirements
• NCQA Standards
• Health Plan Quality Programs
• Clinical Program Administration
• Quality Program Coordination
• Care Management
• Business Analysis
• Project Management
• Medical Claims
• Pharmacy Claims
• Confluence
• Jira
• Tableau
• Salesforce
• Bilingual in Spanish
• Detail-Oriented
• Analytical

Company

• Health benefit administration platform for employers, unions, and plans
• New York, New York, USA
• https://www.judi.health/
• Founded in 2017
• 501-1000 employees

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
• 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
• 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.

Required skills

• CAHPS, Certified Medical Assistant (CMA) Certification, Confluence, HEDIS, Jira, Licensed Practical Nurse (LPN) License, Managed Care, Medical and Pharmacy Claims, Medicare Stars, Salesforce, Spanish, Tableau

Preferred skills

• $736M, 2024-03-28, 2025-09-23, 2026-09-09, 2026-10-23, Anthony Loiacono, B Capital, CEO & Co-Founder, Chief Administrative Officer, EIN Presswire, Experience in business analysis and project management, Experience with Confluence, Jira, Tableau, Salesforce, Experience working with medical and pharmacy claims, General Catalyst,Wellington Management, Highly detail-oriented and analytical, John Nicolosi, Judi Health Launches Medicare Part D Plan for Employers, Key Investors, Late Stage, Leadership Team, MedCity News, New York, New York, USA, Prime Therapeutics, Recent News, Secondary Market· $148M, Series E· $115M, Series F· $252M, Total Funding, bilingual Spanish, https://www.judi.health

Experience

• 1+ years