Hybrid: Senior Pharmacist Lead, PA Systems & Strategy

Capital Rx Inc.; New York (NY); Hybrid; USD 155,000 - 180,000; Full time

Job summary

Judi Health seeks a licensed pharmacist with leadership experience to manage a team responsible for clinical criteria and prior authorization system configurations. You will oversee policy creation, decision-tree logic, and member communications to ensure compliance and accuracy.

The role supports hybrid work in NYC area, Denver, or Charlotte with a salary range of $155,000–$180,000 USD and standard business hours, flexibility for evolving needs, and a strong focus on quality and compliance.

Qualifications

• Active, unrestricted pharmacist license (PharmD or BPharm required).
• 5+ years of experience in prior authorization or utilization management, with at least 2 years in a leadership or supervisory role.
• Strong understanding of clinical criteria development, formulary management, and benefit design.
• Experience with PA system configuration and letter template mapping preferred.
• Excellent communication, writing, and organizational skills.

Responsibilities

• Lead and mentor a team of pharmacists, technicians, and analysts responsible for PA criteria development, system configuration, and letter template management.
• Oversee the creation and maintenance of clinical criteria and decision trees based on evidence‑based guidelines and plan benefits.
• Lead initiatives to improve member and provider communication through clear, compliant, and user‑friendly denial and approval language.
• Ensure timely and accurate implementation of formulary updates, new drug reviews, and regulatory changes across all lines of business.
• Collaborate with cross‑functional teams to optimize workflows and ensure alignment.
• Drive continuous improvement in PA system configuration, including automation and turnaround time (TAT) compliance.
• Monitor team performance, provide coaching and development, and ensure adherence to quality and compliance standards.
• Serve as a subject matter expert for internal and external stakeholders regarding PA criteria and regulatory requirements.
• Review prior authorization, appeal, and override requests as needed.

Skills

Leadership

Communication

Writing

Organizational skills

Data visualization

Education

PharmD or BPharm

Tools

Microsoft Office Suite

Excel

PA platforms

Data visualization tools

Job description

Judi Health seeks a licensed pharmacist with leadership experience to manage a team responsible for clinical criteria and prior authorization system configurations. You will oversee policy creation, decision-tree logic, and member communications to ensure compliance and accuracy.

The role supports hybrid work in NYC area, Denver, or Charlotte with a salary range of $155,000–$180,000 USD and standard business hours, flexibility for evolving needs, and a strong focus on quality and compliance.