Lead the national go-to-market strategy to acquire new TPA and health plan clients for the Judi SaaS platform. Manage the full enterprise sales cycle from prospecting and discovery to commercial negotiation and closing.
Judi Health
47 Remote Job Openings at Judi Health
Responsible for the satisfaction and retention of large enterprise employer commercial clients by serving as the primary relationship owner. This includes leading the renewal process, managing performance guarantees, and providing proactive plan recommendations based on healthcare trends.
Facilitate Scrum events and coach multiple interdependent teams to improve agile maturity and delivery quality. Lead process improvements, remove impediments, and mentor junior Scrum Masters to foster a culture of continuous improvement.
Lead analytics projects to deliver strategic insights on pharmacy program performance, compliance, and financial projections. Collaborate with cross-functional teams and clients to provide data-driven recommendations for plan management and process optimization.
Responsible for reviewing clinical coverage determinations and appeals for Commercial and Medicare lines of business based on medical necessity. This includes collaborating with Medical Directors, performing peer-to-peer reviews, and documenting decisions using scientific literature.
Prepare and validate prior authorization requests by gathering clinical information from providers and members. Triage phone calls and analyze pharmacy claims data to ensure accurate clinical determinations for pharmacist review.
The Associate Product Manager will collaborate with cross-functional teams to develop scalable data models and a prioritized roadmap for the Enterprise Data Warehouse. They are responsible for managing the product backlog, conducting user testing, and translating business needs into technical specifications.
Facilitate Scrum events and coach development teams to improve agility, transparency, and self-organization. Remove impediments and collaborate with product teams on backlog management and release forecasting.
Prepare and validate prior authorization requests by obtaining necessary clinical information from providers and prescribers. Triage communications from members and pharmacies while ensuring adherence to HIPAA guidelines and internal operating procedures.
Develop and productionize multimodal LLMs and AI-based automation tools for healthcare applications. Manage the full ML lifecycle from data pipeline creation and fine-tuning to deployment and security compliance.
Lead and mentor a team of IT Engineers to oversee day-to-day operations and the delivery of enterprise IT services. Drive strategic initiatives to improve identity, endpoint management, and SaaS platforms while serving as the final escalation point for technical issues.
Utilization Manager Appeals Technician (Temp to Hire)
Judi Health
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Part Time
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18 days ago
Judi Health
Responsible for processing first, second level, and external appeals for various lines of business including Commercial, Exchange, and Medicare. This involves verifying case qualifications, coordinating with pharmacists and medical directors, and communicating with members and providers.
Oversee a group of prior authorization technicians and manage administrative pharmacy functions. Coordinate with management to optimize staffing, workflow, and system enhancements while resolving escalated client and provider issues.
The Medical Director performs medication utilization reviews and medical necessity appeals for various client programs. They provide peer-to-peer support to prescribers and contribute to the development of clinical policies and UM criteria.
Drive client adoption of the Judi Care platform by leading product demonstrations, facilitating trainings, and creating comprehensive user documentation. Act as a subject matter expert to triage client feedback and partner with product teams to influence the development roadmap.
Lead the cloud security strategy and engineering execution across AWS environments, focusing on FedRAMP readiness and continuous compliance. Partner with cross-functional teams to embed security into AI initiatives and maintain a resilient cloud architecture.
The developer will build and enhance a web-based enterprise health platform by implementing new features and improving existing functionality. This includes writing clean, maintainable code and collaborating with product managers and designers in an Agile environment.
Collaborate with product managers and engineers to execute the product roadmap and deliver member experience enhancements. Responsibilities include triaging technical data errors, building business requirements, and managing the product backlog.
Responsible for the day-to-day operations of group benefits programs, including vendor management and employee support. Ensures regulatory compliance for benefits and leave programs while managing open enrollment and HRIS data accuracy.
Utilization Management Pharmacist (Temp, Temp-to-hire)
Judi Health
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Part Time
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a month ago
Judi Health
The pharmacist reviews prior authorization requests, appeals, and overrides using evidence-based clinical guidelines. They provide expert guidance to members, providers, and pharmacies while ensuring compliance with regulatory standards.
Responsible for the secure exchange and transformation of healthcare data files including claims and eligibility between the company and its partners. The role involves monitoring data feeds, resolving errors, and optimizing integration processes for medical, dental, and vision data.
Build and maintain scalable, secure infrastructure and automation pipelines to enable faster feature delivery. Manage container orchestration, serverless architectures, and database performance while ensuring compliance with healthcare security standards.
Lead administrative and operational tasks to execute clinical programs, including triaging calls, conducting outreach, and maintaining drug lists. Support reporting requirements and collaborate with internal stakeholders to ensure quality patient care and safety standards.
Manage large commercial pharmacy benefit accounts by serving as the primary relationship liaison and developing strategic plans. Oversee client renewals, performance guarantee reporting, and provide proactive recommendations based on healthcare trends.
Manage the planning, growth, and retention of clients within the Pharmacy Benefit Administration market segment. Act as the primary advocate and leader for the account management team to ensure client satisfaction and contractual obligations are met.
Manage the full client lifecycle from implementation to renewal, focusing on benefit changes and pricing accuracy for PBA and Medicare plans. Lead quality assurance initiatives and claim reviews to ensure operational efficiency and high client satisfaction.
Serve as the primary L&D partner for the Technology organization to diagnose performance needs and design scalable learning solutions. Lead the creation of technical onboarding resources and manage the end-to-end delivery of enablement portfolios.
The Appeals Technician is responsible for managing incoming first, second, and external appeals while ensuring high-quality customer service and productivity. They must maintain compliance with HIPAA guidelines, perform quality reviews, and coordinate with pharmacists and medical directors to process cases efficiently.
The UX/UI Designer will create user-centered interfaces and experiences while ensuring visual consistency and accessibility across product features. They will collaborate with cross-functional teams to conduct usability testing and maintain the design system.
The Senior Project Manager will lead the development and execution of pharmacy benefit cost-savings programs across various lines of business. This role involves managing cross-functional teams, overseeing vendor relationships, and utilizing data analytics to drive program quality and continuous improvement.
The Senior Project Manager will lead the development and execution of market access programs across various lines of business while managing vendor relationships and operational workflows. They will also collaborate with analytics teams to assess program performance and support commercialization efforts through pricing and marketing enablement.
The Clinical Account Manager will lead and develop relationships with key healthcare decision-makers to ensure client satisfaction and retention. They will analyze pharmacy claims data to provide actionable clinical insights and strategic recommendations.
Lead administrative and operational tasks to support the implementation and management of clinical programs such as pharmacogenomics and drug utilization review. Manage large-scale projects, analyze data sets to monitor quality, and support business development needs including client contracting and vendor management.
The VP of Provider Reimbursement and Contracting will architect and advance network solutions, integrating payment innovation and high-performing provider partnerships. This role involves leading provider contract negotiations, developing value-based payment models, and aligning network strategies with product design to optimize total cost of care.
The Case Underwriter will execute day-to-day pricing and underwriting for new and renewing business opportunities while collaborating with sales and executive teams. They are responsible for refining financial models, supporting client contracting, and maintaining underwriting system infrastructure.
The Clinical Account Consultant will manage client clinical needs, including formulary strategy, trend analysis, and clinical plan implementation. They will also collaborate with cross-functional teams to support sales initiatives and contribute to clinical process improvements.
This role supports the Head of Benefits and Compensation by creating project plans, documenting workflows, and analyzing current HR processes to identify improvements and automation opportunities. Key duties include tracking employee contributions, managing job descriptions, and handling employee inquiries regarding compensation, benefits, and payroll.
The specialist will be responsible for all aspects of benefit configuration, including new plan setup, plan changes, claims testing, and regular audits, while driving cross-functional collaboration to ensure client customizations are configurable. They must clearly communicate complex setup and testing processes to non-expert users and develop standards for batch testing scenarios.
The engineer will define, own, and build the organization-wide observability strategy, tooling, and platform products, architecting a custom platform for visibility into logs, metrics, and traces. Responsibilities include building production-grade internal products using React/TypeScript frontends with Python and Rust backends to improve debugging and monitoring.
The Senior Data Engineer will be responsible for building and maintaining reliable data models within Snowflake using dbt, focusing on improving data quality and observability. This role involves collaborating with analysts, data scientists, and software engineers to deliver trusted, well-documented datasets that support analytics and products.
This role focuses on building and scaling the analytics foundation by developing high-quality, analytics-ready datasets and a consistent metrics/semantic layer using dbt and Snowflake. Responsibilities include designing durable data models, defining trusted business metrics, ensuring data quality through testing, and partnering with stakeholders to create reusable data products.
This role involves combining technical leadership with hands-on coding to develop scalable, high-impact healthcare technology, exercising leadership over features from design through delivery. Responsibilities include partnering with product, design, and QA teams, becoming a subject matter expert, and expanding the enterprise health platform using specified technologies.
Senior Manager Government Program Operations (Exchange)
Judi Health
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Full Time
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4 months ago
Judi Health
The Senior Manager leads the end-to-end implementation, governance, and change management of regulatory requirements for Exchange plans and EDGE Server operations, overseeing CMS submissions, compliance, and audit responses. This role involves interpreting CMS and state guidance to ensure all regulatory reporting obligations for Exchange clients are met through structured research, analysis, testing, and validation of systems and workflows.
Lead the design and implementation of user-facing features and backend services. Monitor and troubleshoot production issues while driving reliability and performance improvements.
Senior Scalability Engineer - Streaming & Realtime Systems
Judi Health
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Full Time
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4 months ago
Judi Health
The Senior Scalability Engineer will own the architecture and expansion of streaming data infrastructure, focusing on high-impact performance challenges. Responsibilities include designing and implementing systems for database changes, building CDC systems, and ensuring data reliability.
The Clinical Program Business Development Manager will drive the sales strategy for Capital Rx’s clinical programs, from prospecting to closing deals. This role involves assessing client data, delivering presentations, and managing relationships to foster program adoption.
The Senior AI/ML Applied Scientist will investigate and evaluate the latest LLM and MLM models for healthcare applications, develop data pipelines, and productionize machine learning solutions. They will also participate in the complete lifecycle of ML model development and ensure compliance with healthcare data regulations.
