Clinical Programs Administrations Pharmacist

About Judi Health

Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single, secure platform. By delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels.

At Judi Health, we're deploying the infrastructure our country needs to deliver the healthcare we all deserve. We are the intelligence platform powering benefits plans for millions of Americans and proudly leading the next generation of care. To learn more, visit www.judi.health .

Location: Remote (United States)

Position Summary:

Acts as a subject matter expert, providing comprehensive support for the operations of clinical programs and associated initiatives. This includes, but is not limited to, prioritizing incoming calls, conducting outreach, effectively communicating issues and resolutions to stakeholders, and adhering to internal Standard Operating Procedures, job aids, Policies and Procedures, as well as complying with HIPAA guidelines and policies.

Position Responsibilities:

Triage clinical incoming calls and conduct clinical outreach calls to members, pharmacies, and prescribers

Support operations of clinical programs, including pharmacogenomics, MTM (Medication Therapy Management), lower cost alternative, retrospective drug utilization reviews, and other clinical initiatives as needed

Provide on call support as needed for after-hours pharmacist/clinical programs/emergent calls on rotating schedule that includes nights, weekends, and holidays

Ensure customer satisfaction, demonstrate genuine compassion and care, optimize the customer experience, and provide professional customer support and service

Meet or exceed performance metrics while maintaining quality and providing superior customer service to all stakeholders

Effectively ask probing questions to identify and resolve multiple issues and address concerns effectively, efficiently, and in a timely manner

Communicate issues and resolutions to members, pharmacies, providers, and appropriate internal stakeholders

Remain current on all communications and updated processes relayed through multiple communication channels and apply to daily responsibilities

Follow all internal Standard Operating Procedures, job aids, Policies and Procedures, and adhere to HIPAA guidelines and policies

Follow all procedures to protect patients through safeguards for data integrity, confidentiality, and security of information as required by policies and procedures and accreditation entities

Support the Fraud, Waste, and Abuse program by reviewing pharmacy claims information and communicating findings to appropriate internal staff

Deliver extraordinary customer care and service by responding to questions concerning customer accounts in a fast paced, structured environment within established time frame

Support Manager/Supervisor by assisting with additional projects as requested

Support staff training and development as required

Work collaboratively with internal business and clinical partners to support initiatives including clinical interventions, data and claims review, and on-boarding of new clients, as required

Maintain compliance with federal, state, local, and organizational laws, regulations, guidelines, and policies

Responsible for adherence to the Capital Rx Code of Conduct, including reporting of noncompliance.

Minimum Qualifications:

Active, unrestricted pharmacist license

Bachelor's or Doctor of Pharmacy Degree with 2+ years of clinical pharmacy practice experience

Experience in customer service or call center experience required

2+ years of prior managed care and/or clinical program administration experience and/or completion of a PGY1 Pharmacy Residency Program required

Excellent communication (oral and written) and organizational skills

Ability to work independently with minimal supervision, stay productive in a remote, high-volume, metric driven call center environment

Self-motivated and detail-oriented problem solver

Ability to handle multiple competing priorities in a dynamic environment and collaborate in a team

Have a designated workspace (an office, spare bedroom, etc.) that is visibly secure from others during work hours (closed door) and is protected from noise that could disrupt conversations

Have the following internet connectivity: DSL, cable modem or fiber with a wired connection to device (wi-fi not allowed). Internet speed of one gigabyte (940bps) is required

Preferred Qualifications:

Pharmacogenomics (PGx) certification highly preferred

Medication Therapy Management (MTM) experience preferred

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.

Remote, US Salary Range

$130,000 — $135,000 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 .