Lead Pharmacist – Prior Authorization Systems & Criteria

Capital Rx Inc.; Charlotte (NC); Hybrid; USD 155,000 - 180,000; Full time

Job summary

Judi Health is seeking a licensed pharmacist with leadership experience to manage a team responsible for clinical criteria and prior authorization (PA) system configurations. You will oversee the creation of utilization management policies, decision trees, and member-facing communications to ensure compliance, efficiency, and clinical accuracy.

The ideal candidate brings strategic thinking, strong clinical knowledge, and a passion for leading high-performing teams in a dynamic environment.

Qualifications

• Active, unrestricted pharmacist license (PharmD or BPharm required).
• 5+ years of experience in prior authorization or utilization management with leadership.
• Strong understanding of clinical criteria development, formulary management, and benefit design.

Responsibilities

• Lead and mentor a team of pharmacists, technicians, and analysts responsible for PA criteria development and system configuration.
• Oversee the creation and maintenance of clinical criteria and decision trees based on guidelines and plan benefits.
• Improve member and provider communications with clear denial/approval language.
• Ensure timely formulary updates, new drug reviews, and regulatory changes across lines of business.
• Collaborate with Formulary, Benefits, Product/Development, Regulatory/Compliance, and PA Operations to optimize workflows.
• Drive automation and self-service tools to reduce turnaround time (TAT).
• Monitor team performance, provide coaching and development, ensure quality/compliance.
• Serve as SME for PA criteria, system capabilities, and regulatory requirements.

Skills

Leadership

Communication

Organizational skills

Excel

PA knowledge

Education

PharmD or BPharm

Tools

PA platforms

Data visualization tools

Job description

Judi Health is seeking a licensed pharmacist with leadership experience to manage a team responsible for clinical criteria and prior authorization (PA) system configurations. You will oversee the creation of utilization management policies, decision trees, and member-facing communications to ensure compliance, efficiency, and clinical accuracy.

The ideal candidate brings strategic thinking, strong clinical knowledge, and a passion for leading high-performing teams in a dynamic environment.