Prior Authorization Systems Technician

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

About Judi Health

Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including a public benefit corporation delivering full‑service pharmacy benefit management (PBM) solutions, a full‑service health benefit management platform, and an industry‑leading proprietary Enterprise Health Platform (EHP) that consolidates all claim administration‑related workflows in one scalable, secure platform.

Location: Hybrid (Local to New York, NY, Charlotte, NC or Denver, CO area)

Position Summary

Responsible for the maintenance, configuration, and validation of prior authorization (PA) criteria, decision trees, and communication templates within the PA system. Supports accurate translation of clinical requirements into system logic through routine updates, testing, and quality checks. Partners with pharmacists and cross‑functional teams to ensure data integrity, resolve issues, and maintain efficient, compliant PA operations.

Position Responsibilities

• Evaluate and operationalize weekly formulary and utilization management (UM) updates, including criteria changes, product additions, and retirements
• Maintain and configure prior authorization (PA) criteria, rules, and source documentation within the PA platform, ensuring alignment with clinical and formulary intent
• Experience creating or maintaining prior authorization decision trees, rules engines, or clinical workflows strongly preferred
• Ability to interpret clinical guidelines and translate them into structured logic or system configurations
• Experience documenting clinical rationale or supporting materials for utilization management criteria preferred
• Perform structured validation and quality assurance (QA) of criteria builds, letter templates, and system configurations prior to deployment
• Partner with Formulary Operations and Clinical teams to identify and resolve discrepancies in criteria logic, coding, or documentation
• Support new drug‑to‑market implementations, including analysis and updates for GPI, NDC, and other product identifiers impacting existing authorizations
• Maintain and enhance letter templates and automated communications to ensure regulatory compliance and operational consistency
• Execute and support batch load testing, regression testing, and release validation for system updates and enhancements
• Act as a subject matter resource for PA criteria setup, troubleshooting issues, and answering internal inquiries from operations, pharmacists, and business partners
• Monitor and triage system or configuration issues, escalating appropriately and partnering with IT/vendor teams for resolution
• Conduct intake and pre‑review preparation of PA cases by validating member, provider, and clinical information against guideline requirements
• Proactively obtain and organize clinical documentation to ensure completeness and readiness for pharmacist or clinician review
• Collaborate cross‑functionally with Clinical, Operations, IT, and Business teams to support system improvements, process optimization, and implementation initiatives
• Identify opportunities for workflow efficiency, automation, and data quality improvement within the PA process
• Adapt quickly to shifting priorities and support multiple concurrent initiatives in a fast‑paced environment

Required Qualifications

• 4+ years of pharmacy technician experience in a PBM, health plan, or clinical pharmacy environment
• Demonstrated 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
• High attention to detail with a focus on data accuracy and configuration quality
• Ability to troubleshoot system or workflow issues and communicate clearly with technical and non‑technical stakeholders
• Proficiency in Microsoft Excel and Word; ability to work with structured data and perform basic analysis (e.g., validation, comparisons, tracking updates)
• Experience working cross‑functionally with clinical, operational, and/or IT teams preferred
• Bachelor’s degree or equivalent combination of education and experience preferred
• Depending on the changing needs of the business, you may be required to work rotating weekends and/or participate in an on‑call schedule in the future.

Salary ranges by location:
New York, NY: \$75,000 – \$80,000 USD
Denver, CO: \$75,000 – \$80,000 USD
Charlotte, NC: \$75,000 – \$80,000 USD

Benefits

• Full‑time and part‑time benefit‑eligible employees receive medical, pharmacy, dental, vision, accidental injury, critical illness, and hospital indemnity coverage, as well as flexible spending accounts.
• Full‑time employees have access to a health savings account, voluntary life insurance, and voluntary accidental death and dismemberment insurance for themselves and eligible dependents.
• At no cost to the employee: basic life insurance, basic accidental death and dismemberment insurance, paid time off, sick time, holidays, short‑term disability, long‑term disability, an employee assistance program, and a wellness program.
• Full‑time employees are eligible for a 401(k) plan with company match after one year of full‑time employment.

We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

All employees are responsible for adherence to the Judi Health Code of Conduct, including the reporting of non‑compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.

By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at https://www.judi.health/legal/privacy-policy.