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.
Collaboration, Reporting & Continuous Improvement
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.
