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 Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single,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.
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.
Skills Required
- Active, unrestricted pharmacist license
- Bachelor’s or Doctor of Pharmacy degree
- At least 2 years of clinical pharmacy practice experience
- Customer service or call center experience
- At least 2 years of managed care and/or clinical program administration experience, or completion of a PGY1 Pharmacy Residency Program
- Excellent oral and written communication skills
- Strong organizational skills
- Ability to work independently with minimal supervision in a remote, high-volume, metric-driven call center environment
- Self-motivated and detail-oriented problem-solving ability
- Ability to manage competing priorities and collaborate with a team
- Secure, private, quiet designated workspace with a closed door
- Wired DSL, cable modem, or fiber internet connection; specified high-speed internet service
- Pharmacogenomics certification
- Medication Therapy Management experience
What We Do
Judi Health is a health technology company providing a comprehensive suite of solutions for employers and health plans, including: - Capital Rx: a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers - Judi Health™: full-service health benefit management for employers, TPAs, and health plans - Judi®: a single, scalable SaaS solution that health plans can utilize to manage all their claim workflows Through these solutions, Judi Health is executing on its mission to give our country the infrastructure it needs for the healthcare we deserve. To learn more, visit www.judi.health.
