Current openings at Judi Health

Position Summary: The Formulary Operations Pharmacist – Medicare is responsible for providing operational support for the evaluation, implementation, and maintenance of Medicare Part D formularies and utilization management. This individual supports creation and maintenance of formulary and utilization management lists, preparation of CMS formulary files and member formulary drug lists, preparation and review of updates for implementation, and other formulary and utilization management related tasks and processes. The role requires strong cross functional collaboration and communication skills, and an understanding of Medicare Part D formulary management processes and related CMS rules and regulations. Position Responsibilities: Maintain standard and custom formularies for the Medicare line of business in accordance with CMS Medicare guidelines Support development, implementation, maintenance, and quality control of Medicare Part D formularies, utilization management, and clinical adjudication drug lists Lead and support preparation of monthly and annual files for CMS formulary submissions, member formulary drug lists and look up tools, and utilization management criteria Evaluate drugs/drug classes, make formulary positioning and utilization management recommendations, and update formulary management strategies and associated adjudication requirements to operationalize Evaluate appropriateness of and operationalize custom client formulary and benefit change requests within the formulary and adjudication platform Support comprehensive testing of client formulary and benefit elections Provide cross functional support for claim troubleshooting within the adjudication platform Monitor and analyze regulatory and legislative requirements for Medicare Support development of project plans to meet new CMS requirements, and support cross functional teams with implementation of programs to meet requirements Lead formulary change processes within URAC/NCQA/CMS guidelines Pharmacy and Therapeutics (P&T) Committee participation as an ad hoc member Conduct formulary reviews and develop drug monographs based on a rotation of clinical pharmacists Maintain and update the Capital Rx pharmaceutical pipeline, as needed Develop clinical criteria for review as needed Support CMS formulary administration audits Support quality improvement projects as needed Support Request for Information (RFI) and Request for Proposal (RFP) submissions, as needed Support general business needs and operations, as needed Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance. Minimum Qualifications: Doctor of Pharmacy (PharmD) Degree from an accredited institution, with record of strong academic performance Current, unrestricted registered pharmacist license(s) Residency/fellowship preferred 2-3 years of formulary experience working for a health plan or PBM preferred 2-3 years of Medicare experience preferred Knowledge of formulary development and maintenance processes Knowledge of highly managed specialty medications/strategy Knowledge of rebate and financial implications of formulary strategies Experience working with large datasets preferred Ability to independently identify, research, and resolve issues Ability to balance multiple complex projects simultaneously Ability to work extended hours, weekends, and holidays consistent with industry demands Exceptional written and verbal communication skills Extremely flexible, highly organized, and able to shift priorities easily Attention to detail & commitment to delivering high quality work product Microsoft office suite with emphasis on Microsoft excel proficiency required #LI-BC1

Location: Hybrid (Local to NYC or Denver Metropolitan areas) Job Summary: We are seeking a highly technical and detail-oriented Senior Analyst to support our growing Analytics team. This role requires deep expertise in data analysis, reporting frameworks, and coding best practices. The ideal candidate will have a strong background in executing analytics projects, collaborating with cross-functional teams, and providing actionable insights to support business decisions. With more than 3 years of experience in data analytics, this individual will drive efficiency, consistency, and innovation within the organization’s Analytics team.  Key Responsibilities:   Analytical Project Execution  Lead analytics projects, collaborating with business stakeholders to develop and deliver reporting solutions and actionable insights.  Produce strategic insights on program performance, compliance, utilization trends, and financial projections.  Ensure data integrity by developing and maintaining clear documentation of query logic, methodologies, and key assumptions.  Cross-Functional Collaboration  Work cross-functionally with internal teams to align analytical insights with business objectives, regulatory requirements, and financial considerations.  Proactively engage and partner with stakeholders on project scoping, logic development, and documentation.  Advocate for data-driven decision-making across teams and leadership.  Data Analysis and Reporting  Apply expertise in data analytics to identify opportunities for process optimization, automation, and improved reporting methodologies.  Translate complex data findings into actionable insights, creating visualizations and presentations for stakeholders ranging from operational teams to executive leadership.  Build and maintain standard and ad hoc reports.  Compliance and Quality Control  Ensure adherence to company compliance standards, including reporting any noncompliance.  Support the development and implementation of quality controls and departmental standards to satisfy organizational and regulatory requirements.  Participate in internal training sessions to support continued learning and development.  Responsible for adherence to the Capital Rx Code of Conduct, including reporting of noncompliance.    Qualifications & Experience:   3+ years of experience in data analytics, business intelligence, or a related field.  1+ years of experience in PBM, health plans, healthcare, or Medicare.  Experience working with pharmacy claims data, medical claims data, and client reporting metrics.  Proficiency in SQL, Python, or R for data analysis, with strong coding hygiene and documentation practices.  Hands-on experience with BI tools such as Tableau.  Knowledge of data engineering fundamentals and working with cloud-based data warehouses (e.g., Snowflake, BigQuery, Redshift).  Strong ability to work cross-functionally with business stakeholders.  Excellent written and verbal communication skills with the ability to present insights effectively.  Experience mentoring team members and leading knowledge sharing.  Attention to detail & commitment to delivering high quality work product.  Preferred Qualifications:  Experience working in large-scale, high-growth organizations.  Knowledge of machine learning or advanced statistical modeling techniques.  Familiarity with Agile project management methodologies.  Bachelor’s degree in Computer Science, Actuarial Science, Statistics, Economics, or a related field.  GitHub and dbt experience.  Why Join Us?   Contribute to a highly skilled, technical analytics team in a dynamic and data-driven organization.  Support strategic decision-making and build a scalable data foundation for business growth.  Work with cutting-edge technologies and make a meaningful impact on the organization.