Clinical Programs Case Management Specialist
New
J
Judi HealthHealth technology
RemoteFull-TimeMiddle
Salary65,000 - 70,000 USD per year
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Job Details
- Languages
- Spanish (preferred)
- Experience
- Minimum of 3 years of experience in a clinical setting, pharmacy benefit management (PBM), health plan, or related healthcare environment; at least 1 year of customer service experience.
- Required Skills
- Microsoft OfficeDocumentationCustomer service
Requirements
- Minimum 3 years of experience in a clinical setting, PBM, health plan, or healthcare environment.
- At least 1 year of customer service experience with strong communication and relationship-building skills.
- Experience with electronic medical records (EMRs), patient assistance programs (PAPs), and healthcare documentation systems.
- Experience with prescriber office workflows.
- Ability to manage multiple priorities and complex projects independently.
- Reliable high-speed wired internet (DSL, cable, or fiber) with minimum 940 Mbps (1 Gigabit) speed.
- Proficiency in Microsoft Office Suite (Excel and PowerPoint) preferred.
- Experience with Confluence, Jira, Tableau, and Salesforce preferred.
- Experience with infusion providers, vendor relations, and medical claims/billing preferred.
- Bilingual (Spanish) preferred.
Responsibilities
- Manage site-of-care optimization program referrals through outreach to members, prescribers, pharmacies, and healthcare stakeholders.
- Educate members on infusion therapy options, benefit considerations, and support resources.
- Coordinate with care navigators and patient coordinators to facilitate referrals and ensure continuity of care.
- Document outreach, interventions, and outcomes accurately in internal systems.
- Maintain program resources including drug lists, workflows, and operational materials.
- Collaborate with clinical, operational, and account management teams to support program success.
- Identify trends and workflow inefficiencies to support quality improvement and operational excellence.
- Ensure adherence to HIPAA regulations and organizational compliance standards.
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