Clinical Programs Specialist

Judi Health•Denver, CO

5d•$65,000 - $75,000•Remote

About The Position

The Clinical Programs Specialist provides operational and administrative support for the 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. It helps ensure that program processes are carried out consistently, accurately, and in accordance with contractual, regulatory, and organizational requirements, supporting effective operations and timely, high-quality service for clients and members. The position supports assigned clinical programs and vendor relationships, including workflow and documentation maintenance, monitoring shared inboxes and work queues, documenting activities and decisions, and helping resolve operational gaps and stakeholder inquiries. It also supports vendor service-level monitoring, reporting, invoicing, client implementation requests, claims monitoring, member communication proofs, business development needs, and ongoing program maintenance. The role is remote in the United States. The anticipated base salary range is $65,000–$75,000 USD, with actual pay dependent on factors such as experience, skills, knowledge, and job location.

Requirements

Active, unrestricted pharmacy technician license, licensed practical nurse (LPN) credential, 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 disruptive noise.
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 operations 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 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 established deadlines with minimal oversight.
Maintain clinical program resources, including drug lists, through routine reviews, scheduled updates, and ad hoc changes.
Support 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 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.
Stay current on organizational communications, clinical updates, and process changes and apply them to daily work.
Uphold general business needs and operations as required.
Adhere to the Judi Health Code of Conduct, including reporting non-compliance.