3-5 years relevant experience in health plan or pharmacy benefits management (PBM)
Direct account management experience with clients across multiple business lines
Proficient in Microsoft Excel and experience with large datasets
Responsibilities
Support clinical implementation for new clients and plan changes, including building/coding plans and conducting quality control
Address clients' clinical needs, managing custom formularies and clinical strategies
Explain formulary and clinical programs to clients, ensuring clarity on interventions and regulatory requirements
Meet with clients to discuss clinical trends and provide actionable recommendations
Analyze pharmacy claims data to identify trends and insights for clients
Communicate drug information and resolve plan-specific inquiries
Collaborate with cross-functional teams on sales initiatives and presentations
Benefits
Flexible work environment to accommodate different work styles
Opportunity for professional development within a growing organization
Engagement in meaningful work that drives healthcare innovation
Collaborative team culture that fosters excellence and clinical leadership
Contribution to client satisfaction and retention in the health industry
Full Job Description
Position Summary:
Judi Health is seeking a strategic, client-focused Clinical Account Consultant to support all aspects of clinical functions to service client clinical needs. In this role, you'll ensure client satisfaction, retention, and trend management, while providing clinical support to clients across all lines of business. You'll collaborate directly with clients to develop and implement formulary and clinical strategies, support contract renewals, and contribute to clinical process improvements. If you're passionate about delivering exceptional service with a focus on clinical excellence and driving healthcare innovation, we'd love to hear from you!
Position Responsibilities:
Support clinical aspects of implementation for new clients, plans, plan changes, and other clinical plan set-up requirements. This may include gathering client clinical intent and plan requirements, building/coding plans and formularies, conducting peer-review quality control, and reviewing testing and claims output.
Actively address all clients' clinical needs including the management and implementation of custom formularies, clinical criteria, and clinical strategies.
Comprehend and effectively explain formulary, benefit, and clinical programs to clients, including intervention components, member and plan experience, book of business experience, and regulatory requirements as it directly pertains to clinical functions.
Meet with clients to discuss clinical trends, review relevant pharmacy data, and provide recommendations with supportive rationale for formulary, clinical and plan management strategies.
Analyze and interpret pharmacy claims data to identify clinical and plan trends and to offer insights for individual clients and across multiple clients.
Communicate drug information to clients and respond to plan-specific clinical inquiries; support resolution of member-specific inquiries.
Collaborate with cross-functional teams to support sales initiatives, requests for information (RFI), requests for proposal (RFP), and prospect presentations.
Actively attend and contribute to sales meetings and client presentations with a focus on clinical operations and clinical account management.
Lead key internal clinical operations initiatives and general business needs/operations, as required.
Identify and contribute to clinical process improvement efforts.
Certain times of year may require meeting participation, testing, claims review, or other requirements outside of standard business hours, including weekends.
Responsible for adherence to the Judi Health Code of Conduct including reporting of noncompliance.
Required Qualifications:
Doctor of Pharmacy (PharmD) degree from an accredited institution
Relevant experience of 3-5 years in a health plan or pharmacy benefits management (PBM)
Direct account management experience supporting clients across multiple lines of business
Proficient in Microsoft Office Suite with emphasis on Microsoft Excel
Experience working with large datasets and analyzing raw data in Excel
Ability to balance multiple complex projects simultaneously
Exceptional written and verbal communication skills
Flexible, highly organized, and able to shift priorities easily
Attention to detail & commitment to delivering high quality work product
Ability to travel and present to small and large groups
Preferred Qualifications:
Completion of managed care residency, preferred
Prior account management experience of at least three (3) years, preferred
Prior experience with Medicare line of business, preferred
New York, NY Salary Range
$139,600-$174,500 USD
Denver, CO Salary Range
$128,000-$160,000 USD
Charlotte, NC Salary Range
$116,400-$145,500 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.
