Clinical Programs Specialist

Judi Health•Charlotte, NC

4d•Remote

About The Position

The Clinical Programs Specialist provides operational and administrative support for day-to-day management of clinical programs and clinical vendor partnerships under the direction of the Clinical Programs Specialists Manager. The role coordinates program reporting, vendor invoices, and drug list maintenance; maintains program workflows and documentation; supports implementations; monitors recurring deliverables; assists with stakeholder communications; and tracks issues through resolution. The Specialist helps ensure established program processes are carried out consistently, accurately, and in accordance with contractual, regulatory, and organizational requirements so stakeholders are informed and clients and members receive timely, high-quality support. The position supports clinical program administration, workflow management, vendor and stakeholder coordination, and quality and compliance activities. It may also support business development needs, including client contracting, vendor management, opportunity analyses, and program sales support. The role is remote in the United States and requires a secure, quiet workspace and internet connectivity that meet company remote-work standards.

Requirements

Active, unrestricted pharmacy technician license, licensed practical nurse (LPN) license, certified medical assistant (CMA) credential, or equivalent license in healthcare administration, public health, or health sciences.
At least 1 year 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.
A designated workspace that is visibly secure from others during work hours, with a closed door, and protected from noise that could disrupt conversations.
Internet connectivity consistent with company remote-work standards.

Nice To Haves

Experience supporting clinical vendors, maintaining service-level or performance tracking, and supporting project implementations.
Experience in 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, or Salesforce.
Highly detail-oriented and analytical.
Bilingual Spanish.

Responsibilities

Support administration and operational activities for assigned clinical programs involving clinical vendor partners.
Maintain 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.
Apply established workflows and assist with updates when processes, systems, client requirements, or regulatory guidance change.
Identify workflow gaps, document operational risks, and escalate recommendations to the Clinical Partnerships Lead.
Balance multiple workstreams, prioritize time-sensitive activities, and meet deadlines with minimal oversight.
Maintain clinical program resources, including drug lists, through routine reviews, scheduled updates, and ad hoc changes.
Monitor 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 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 support communication, coordination, client experience, and continuity of member care.
Support Clinical Programs Business Development needs, including client contracting, vendor management, opportunity analyses, and program sales support.
Maintain compliance with applicable federal, state, local, and organizational regulations, policies, and guidelines.
Adhere to HIPAA requirements, internal SOPs, and company policies in daily responsibilities.
Remain current on organizational communications, clinical updates, and process changes, and apply them to daily work.
Support general business needs and operations as required.
Adhere to the Judi Health Code of Conduct, including reporting non-compliance.