Clinical Programs Case Management Specialist at Judi Health

Job description

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 Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single,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 . Position Summary: 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. Position Responsibilities: Clinical Programs Administration 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. Program Coordination & Case Management 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. Collaboration & Stakeholder Engagement 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. Quality Improvement & Operational Excellence 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 st