Prior Authorization Systems Specialist

Judi Health; Denver (CO); Hybrid; USD 75,000 - 80,000; Full time

Benefits offered by this job

Medical coverage

401(k) with company match

Paid time off & disability benefits

Job summary

Judi Health is a hybrid-position focused on maintaining and validating prior authorization (PA) criteria, decision trees, and communication templates. You will translate clinical requirements into system logic, testing updates, and ensuring data integrity with pharmacists and cross-functional teams.

The role emphasizes collaboration with Clinical, Operations, IT, and business partners to optimize PA processes, implement new drug guidance, and ensure regulatory compliance across communications.

Qualifications

• 4+ years of pharmacy technician experience in a PBM, health plan, or clinical pharmacy environment.
• Experience working with prior authorization systems, UM criteria, or clinical rule configuration.
• National Certified Pharmacy Technician (CPhT) certification required.
• Strong understanding of prior authorization workflows, clinical guidelines, and formulary management.
• Experience supporting system testing (UAT, regression, or configuration validation) preferred.

Responsibilities

• Evaluate and operationalize weekly formulary and UM updates, including criteria changes, product additions, and retirements.
• Maintain and configure prior authorization criteria, rules, and source documentation within the PA platform.
• Experience creating or maintaining prior authorization decision trees, rules engines, or clinical workflows strongly preferred.
• Interpret clinical guidelines and translate them into structured logic or system configurations.
• Document clinical rationale or supporting materials for utilization management criteria.

Skills

Pharmacy technician experience

UAT/testing

Data accuracy

Excel & Word

Cross-functional collaboration

Education

CPhT certification

Bachelor’s degree preferred

Tools

PA systems knowledge

Rules engines/configuration

Job description

Judi Health is a hybrid-position focused on maintaining and validating prior authorization (PA) criteria, decision trees, and communication templates. You will translate clinical requirements into system logic, testing updates, and ensuring data integrity with pharmacists and cross-functional teams.

The role emphasizes collaboration with Clinical, Operations, IT, and business partners to optimize PA processes, implement new drug guidance, and ensure regulatory compliance across communications.