Clinical Programs Case Management Specialist

Program Coordination & Case Management

Collaboration & Stakeholder Engagement

Quality Improvement & Operational Excellence

Compliance & Regulatory Requirements

• 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.

Minimum 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.

Preferred Qualifications

• Proficient in Microsoft Office Suite applications with emphasis on Microsoft Excel and PowerPoint
• Experience with Confluence, Jira, Tableau, Salesforce
• Highly detail-oriented and analytical
• Bilingual- Spanish preferred
• Experience with infusion proviers, vendor relations, and site of care initiatives
• Experience working with pharmacy and medical claims and medical billing
• 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 .