Lead Appeals Pharmacist – Prior Authorization Ops

Transformcap; Colorado; On-site; USD 118,000 - 147,000; Full time

Job summary

Judi Health is seeking a Senior Appeals Pharmacist to lead prior authorization and appeals operations across Commercial, Medicare, and Medicaid lines. You will supervise pharmacists, shape PA workflows, and ensure high-quality, compliant review processes.

Responsibilities include training staff, resolving escalated issues, and collaborating with Medicare leadership to optimize staffing. Strong PBM knowledge and leadership are essential.

Qualifications

• Pharm.D. degree and active pharmacist license required.
• 2 years of clinical pharmacist experience in PBM setting.
• 1+ year in Commercial and/or Medicare appeals.
• Strong PBM knowledge including claims, formulary, PA and appeals.
• Leadership ability to guide a remote or onsite team.

Responsibilities

• Supervise appeal pharmacists and technicians with expanded PA duties.
• Oversee appeal job aids and clinical denial language.
• Analyze data with manager to optimize PA staffing and workflows.
• Train current staff and onboard new Appeals pharmacists.
• Investigate escalated issues from clients and providers.
• Ensure compliance and maintain quality and turnaround times.

Skills

Clinical pharmacist experience

PBM knowledge

Analytical skills

Leadership

Microsoft Office

Education

Doctor of Pharmacy (Pharm.D.)

Active pharmacist license

Tools

Microsoft Office Suite

Job description

Judi Health is seeking a Senior Appeals Pharmacist to lead prior authorization and appeals operations across Commercial, Medicare, and Medicaid lines. You will supervise pharmacists, shape PA workflows, and ensure high-quality, compliant review processes.

Responsibilities include training staff, resolving escalated issues, and collaborating with Medicare leadership to optimize staffing. Strong PBM knowledge and leadership are essential.