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 Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single,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 Director, Clinical Solutions Customer Success serves as a senior clinical and strategic leader supporting Judi Cloud software licensing customers on the JUDI® platform. This role partners with the customers operations teams, Judi Health’s product teams, and executive stakeholders to design, implement, and optimize formularies, utilization management programs, and clinical benefit strategies while ensuring regulatory compliance and exceptional customer satisfaction. The ideal candidate has deep expertise in Medicaid Fee-For-Service pharmacy benefits, formulary management, pharmacy claims adjudication, drug utilization review, CMS and MMIS requirements, rebate programs, and state Medicaid operations. This individual will serve as a trusted advisor to software as a service customers, lead complex implementations and migrations, and provide mentorship across clinical and customer success teams. This role is expected to manage individual contributors within 90-120 days of starting the position. Position Responsibilities: Serve as the senior clinical lead for software licensing strategic customer relationships. Provide guidance on pharmacy benefit design, formularies, preferred drug lists (PDLs), and utilization management programs. Lead Judi Health team members and clients with implementation and migration activities by providing clinical and formulary subject matter expertise, accurate translation of clinical and formulary requirements into JUDI. Advise on Prior Authorization, Step Therapy, Quantity Limits, DUR/cDUR, rebate programs, and state-specific Medicaid requirements. Support CMS certification, MMIS integrations, NCPDP standards, and regulatory compliance initiatives. Partner cross functionally to resolve complex business and system challenges. Create and lead presentations and recommendations to customers and executive stakeholders. Identify operational risks and drive process improvements to enhance client and member outcomes. Develop documentation, training, and best practices supporting programs and internal teams. Mentor team members and provide leadership to individual contributors across customer success and clinical operations functions. Support business expansion efforts through Medicaid subject matter expertise and solution consulting. Required Qualifications: Active, unrestricted Pharmacist license. PharmD or Bachelor Degree in Pharmacy. 15+ years of pharmacy benefit, health plan, Medicaid, or PBM experience. 10+ years supporting Medicaid pharmacy programs, including Fee-for-Service Medicaid. 5+ years of direct leadership of team members. Experience working directly with state Medicaid agencies and regulatory stakeholders. Demonstrated expertise in formulary management, utilization management, pharmacy claims adjudication, and Medicaid drug rebate programs. Experience supporting MMIS implementations, CMS certification activities, and Medicaid compliance requirements. Experience with PBM adjudication platforms such as RxClaim, JUDI, or similar systems. Strong presentation, relationship management, and leadership skills. Experience leading cross-functional teams and complex client initiatives. Experience supporting multiple state Medicaid programs preferred. Knowledge of 340B, supplemental rebates, and federal Medicaid pharmacy regulations preferred SQL, reporting, and healthcare analytics experience, preferred. New York, NY Salary Range $144,800 — $181,000 USD Denver, CO Salary Range $132,800 — $166,000 USD Charlotte, NC Salary Range $120,800 — $151,000 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. 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 judi.health .

Requirements

Must-haves

Serve as the senior clinical lead for software licensing strategic customer relationships.
Lead Judi Health team members and clients with implementation and migration activities by providing clinical and formulary subject matter expertise, accurate translation of clinical and formulary requirements into JUDI.
Advise on Prior Authorization, Step Therapy, Quantity Limits, DUR/cDUR, rebate programs, and state-specific Medicaid requirements.
Support CMS certification, MMIS integrations, NCPDP standards, and regulatory compliance initiatives.
Partner cross functionally to resolve complex business and system challenges.
Create and lead presentations and recommendations to customers and executive stakeholders.
Identify operational risks and drive process improvements to enhance client and member outcomes.
Develop documentation, training, and best practices supporting programs and internal teams.
Mentor team members and provide leadership to individual contributors across customer success and clinical operations functions.
Support business expansion efforts through Medicaid subject matter expertise and solution consulting.
Active, unrestricted Pharmacist license.
PharmD or Bachelor Degree in Pharmacy.
15+ years of pharmacy benefit, health plan, Medicaid, or PBM experience.
10+ years supporting Medicaid pharmacy programs, including Fee-for-Service Medicaid.
5+ years of direct leadership of team members.
Experience working directly with state Medicaid agencies and regulatory stakeholders.
Demonstrated expertise in formulary management, utilization management, pharmacy claims adjudication, and Medicaid drug rebate programs.
Experience supporting MMIS implementations, CMS certification activities, and Medicaid compliance requirements.
Experience with PBM adjudication platforms such as RxClaim, JUDI, or similar systems.
Strong presentation, relationship management, and leadership skills.

Nice-to-haves

Provide guidance on pharmacy benefit design, formularies, preferred drug lists (PDLs), and utilization management programs.
Experience supporting multiple state Medicaid programs preferred.
Knowledge of 340B, supplemental rebates, and federal Medicaid pharmacy regulations preferred
SQL, reporting, and healthcare analytics experience, preferred.

Application prep

Use the role’s language and application details while tailoring your materials.

Keywords to mirror

aisql

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