[Hiring] Clinical Programs Case Management Specialist @Judi Health

Role Description

The Clinical Programs Case Management Specialist is responsible for supporting Judi Health’s site-of-care optimization program by conducting outreach to members, prescribers, and infusion providers to facilitate a seamless transition of infusion services when appropriate. This role serves as a key liaison with external vendors and internal stakeholders to ensure programs are executed effectively and efficiently, stakeholders remain informed, and members receive timely, high-quality support.

Qualifications

• Experience in medical case management, patient care, or healthcare support roles such as hospital pharmacy technician, CNA, RN, outpatient technician, or similar clinical positions.
• Experience working with electronic medical records (EMRs), patient assistance programs (PAPs), healthcare documentation systems, and prescriber office workflows.
• Minimum of 3 years of experience in a clinical setting, pharmacy benefit management (PBM), health plan, or related healthcare environment.
• At least 1 year of customer service experience with a demonstrated commitment to delivering exceptional service through active listening, relationship building, and effective written and verbal communication.
• Ability to manage multiple priorities and complex projects simultaneously while working independently with minimal supervision.
• Reliable high-speed internet service via DSL, cable, or fiber with a wired connection to the work device (Wi-Fi not permitted). Minimum internet speed of 940 Mbps (1 Gigabit) required.

Requirements

• Own the administrative processes related to Judi Rx’s site-of-care optimization program referrals, including conducting and coordinating outreach to members, prescribers, pharmacies, and other healthcare stakeholders.
• Educate members on infusion therapy options, site-of-care alternatives, benefit considerations, and available support resources to promote informed healthcare decisions.
• Coordinate with members, prescriber offices, patient coordinators, and care navigators to facilitate referrals, support continuity of care, and provide status updates throughout the referral process.
• Serve as a liaison between internal teams, providers, and external partners to address questions, resolve issues, and support timely service delivery.
• Deliver compassionate, professional, and customer-focused support while maintaining a positive member and provider experience.
• Accurately document outreach attempts, case activities, interventions, outcomes, and follow-up actions in applicable systems.
• Manage assigned case workloads, outreach queues, and pending activities to support timely case resolution and continuity of care.
• Track and monitor referral progress, escalations, and program-related activities to ensure adherence to established service levels and workflows.
• Maintain program resources, including drug lists, workflow documentation, and operational materials through routine reviews and updates.
• Identify, document, and escalate issues or barriers impacting member access, provider engagement, or program effectiveness.
• Support departmental initiatives and perform additional duties as assigned.
• Partner with clinical, operational, account management, and business teams to support program implementation, execution, and ongoing success.
• Collaborate with internal and external stakeholders to ensure effective communication, care coordination, and issue resolution.
• Support reporting activities, claims monitoring, opportunity analysis, and stakeholder communications related to clinical program performance and outcomes.
• Participate in cross-functional meetings and provide program insights, feedback, and recommendations to support business objectives.
• Identify trends, workflow inefficiencies, and opportunities for process improvement to enhance program performance, operational efficiency, and member outcomes.
• Contribute to the development and refinement of workflows, job aids, training materials, and standard operating procedures.
• Support quality assurance activities and continuous improvement initiatives designed to strengthen program effectiveness and service delivery.
• Maintain compliance with all applicable federal, state, local, contractual, and organizational requirements.
• Adhere to HIPAA regulations, internal policies, standard operating procedures, and confidentiality requirements in the performance of all responsibilities.
• Remain current on clinical program requirements, regulatory updates, organizational communications, and process changes, applying updates appropriately to daily work activities.
• Demonstrate commitment to ethical business practices, data integrity, and protection of member information.

Benefits

• Remote, US Salary Range: $65,000 — $70,000 USD