Senior Appeals Pharmacist Lead — Prior Authorization

Judi Health; Denver (CO); On-site; USD 118,000 - 147,000; Full time

Job summary

Judi Health in Denver, CO is seeking a Pharmacy Benefit Management professional to lead prior authorization and appeals operations across multiple lines of business, ensuring compliance with federal and state regulations. You will supervise appeal pharmacists and staff, develop workflows, and mentor teams to maintain high quality and timely decisions.

Responsibilities include reviewing clinical decisions, collaborating with Medicare and commercial teams, and training new staff while upholding

Qualifications

• Doctor of Pharmacy or Bachelor of Pharmacy degree from an accredited program.
• Active pharmacist license.
• 2 years of experience as a clinical pharmacist in a PBM setting with prior authorization/appeals experience.

Responsibilities

• Supervise a group of appeal pharmacists and technicians.
• Oversee appeal job aids and clinical denial language.
• Analyze data with management to improve staffing, workflow and systems.
• Train staff and onboard new Appeals pharmacists.
• Investigate/resolve escalated issues from clients and providers.
• Collaborate with Medicare supervisor to ensure appropriate staffing and workflows.
• Perform day-to-day PA and appeal reviews, overrides, and education calls.

Skills

Leadership

Analytical skills

Communication with providers

MS Office

Education

Pharm.D.

Bachelor of Pharmacy

Tools

Microsoft Office Suite

Job description

Judi Health in Denver, CO is seeking a Pharmacy Benefit Management professional to lead prior authorization and appeals operations across multiple lines of business, ensuring compliance with federal and state regulations. You will supervise appeal pharmacists and staff, develop workflows, and mentor teams to maintain high quality and timely decisions.

Responsibilities include reviewing clinical decisions, collaborating with Medicare and commercial teams, and training new staff while upholding