Pharmacist Leader: Prior Authorization Systems

Judi Health, LLC; Port Charlotte (FL); Hybrid; USD 155,000 - 180,000; Full time

Job summary

Judi Health is seeking a licensed pharmacist with leadership experience to manage the development, implementation, and maintenance of clinical criteria and prior authorization configurations in a hybrid setup across New York City area, Denver, and Charlotte. The role focuses on evidence-based criteria, decision-tree logic, and clear member communications to ensure compliance and clinical accuracy.

You will lead a team of pharmacists, technicians, and analysts, overseeing formulary changes,

Qualifications

• Active, unrestricted pharmacist license (PharmD or BPharm)
• 5+ years of PA or utilization management experience, with leadership
• Strong understanding of clinical criteria development, formulary management, and benefit design
• Experience with PA system configuration and letter template mapping
• Excellent communication, writing, and organizational skills
• Proficiency with PA platforms and data visualization tools

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 including Formulary, Benefits, Product/Development, Regulatory/Compliance, and Prior Authorization Operations to optimize workflows and ensure alignment.
• Drive continuous improvement in PA system configuration, including automation, self‑service tools, and turnaround time (TAT) compliance.

Skills

Leadership

Clinical criteria development

Utilization management

PA system configuration

Team mentorship

Regulatory compliance

Communication

Education

PharmD or BPharm

Tools

PA platforms

Excel

Data visualization tools

Job description

Judi Health is seeking a licensed pharmacist with leadership experience to manage the development, implementation, and maintenance of clinical criteria and prior authorization configurations in a hybrid setup across New York City area, Denver, and Charlotte. The role focuses on evidence-based criteria, decision-tree logic, and clear member communications to ensure compliance and clinical accuracy.

You will lead a team of pharmacists, technicians, and analysts, overseeing formulary changes,