Lead Appeals Pharmacist – Prior Authorization Expert

Socket.dev; Charlotte (NC); On-site; USD 107,000 - 134,000; Full time

Job summary

Judi Health in New York, NY seeks a pharmacist leader to oversee prior authorization and appeal operations across Commercial, FEHB, Medicare, and Medicaid lines. You will supervise PA staff, ensure regulatory compliance, and drive staffing and workflow improvements.

The role requires a Pharm.D. with active license, PBM experience, and strong analytical and leadership skills. You will mentor teammates and collaborate with providers to optimize care and outcomes.

Qualifications

• Pharmacist degree with active license and PBM experience.
• Experience with Commercial and Medicare appeals.
• Strong analytical and leadership capabilities.

Responsibilities

• Supervise appeal pharmacists and technicians; manage administrative PA functions.
• Oversight of appeal job aids and clinical denial language.
• Analyze data to inform staffing, workflow, and system enhancements.
• Train staff and onboard new Appeals pharmacists.
• Resolve escalated client/provider issues; partner with Medicare supervisor on workflows.
• Perform daily clinical pharmacy functions and education calls with members/providers.
• Make clinical decisions per medical necessity and contract criteria.
• Evaluate literature to support decisions and recommendations to providers.
• Communicate effectively to promote positive health outcomes.

Skills

Pharmacist leadership

PBM knowledge

Analytical skills

Leadership

Microsoft Office

Education

Doctor of Pharmacy (Pharm.D.)

Bachelor of Pharmacy

Tools

Microsoft Office

Job description

Judi Health in New York, NY seeks a pharmacist leader to oversee prior authorization and appeal operations across Commercial, FEHB, Medicare, and Medicaid lines. You will supervise PA staff, ensure regulatory compliance, and drive staffing and workflow improvements.

The role requires a Pharm.D. with active license, PBM experience, and strong analytical and leadership skills. You will mentor teammates and collaborate with providers to optimize care and outcomes.