Prior Authorization Systems Technician

Judi Health; United States; Hybrid; USD 75,000 - 80,000; Full time

Benefits offered by this job

Comprehensive health coverage

401(k) plan with company match

Paid time off

Job summary

Judi Health is seeking a Prior Authorization Specialist responsible for maintaining and validating prior authorization criteria, with the ability to work remotely or in a hybrid setup from locations such as New York, Charlotte, or Denver.

Candidates should have at least 4 years of pharmacy technician experience and a strong understanding of prior authorization workflows. Benefits include comprehensive health coverage and a robust retirement plan.

Qualifications

• 4+ years of pharmacy technician experience in a PBM, health plan, or clinical environment.
• Demonstrated experience with prior authorization systems or clinical rule configuration.
• High attention to detail with a focus on data accuracy.

Responsibilities

• Maintain and validate prior authorization criteria within the PA system.
• Document clinical rationale for utilization management criteria.
• Collaborate cross-functionally to support system improvements.

Skills

Pharmacy technician experience

Prior authorization systems

Attention to detail

Microsoft Excel

Education

Bachelor’s degree or equivalent

Job description

Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including:

• Capital Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers
• Judi Health™, which offers full-service health benefit management solutions to employers, TPAs, and health plans
• Judi®, the industry’s leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform

Together with our clients, we’re rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit www.judi.health.

Location: Remote (for non-local) or 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
• Interpret clinical guidelines and translate them into structured logic or system configurations
• Document 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 before 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 affecting 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
• 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
• 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 (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

Compensation

New York, NY (hybrid) $75,000 – $80,000

Charlotte, NC (hybrid) $75,000 – $80,000

Remote $75,000 – $80,000 (final salary within this range is determined by the candidate’s geographic location and applicable market tier)

This range represents the low and high end of the anticipated base salary range. The actual base salary will depend on several factors such as experience, knowledge, skills, and location of the job.

Benefits

Judi Health provides full‑time and part‑time benefit‑eligible employees with medical, pharmacy, dental, vision, accidental injury, critical illness, and hospital indemnity coverage, as well as flexible spending accounts. Full‑time employees also have access to a health savings account, voluntary life insurance, and voluntary accidental death and dismemberment insurance for themselves and eligible dependents. Full‑time employees receive basic life insurance, accidental death and dismemberment insurance, paid time off, sick time, holidays, short‑term disability, long‑term disability, an employee assistance program, a wellness program, and a 401(k) plan with company match after one year of full‑time employment.

Equal Employment Opportunity

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 Capital Rx Code of Conduct, including the reporting of non‑compliance.