Senior PA Systems Lead Pharmacist (Hybrid)

Transformcap; Colorado; Hybrid; USD 155,000 - 180,000; Full time

Job summary

Judi Health is seeking a licensed pharmacist with leadership experience to manage a team responsible for developing, implementing, and maintaining clinical criteria and prior authorization system configurations across our benefits platforms.

The ideal candidate will drive evidence-based decision trees, ensure compliant member communications, and partner with cross-functional teams to optimize workflows while adhering to regulatory standards.

Qualifications

• Active, unrestricted pharmacist license (PharmD or BPharm required).
• 5+ years in prior authorization or utilization management, with at least 2 years in leadership or supervisory role.
• Strong understanding of clinical criteria development, formulary management, and benefit design.
• Experience with PA system configuration and letter template mapping preferred.
• Excellent communication, writing, and organizational skills.
• Proficient in Microsoft Office Suite, especially Excel; experience with PA platforms and data visualization tools a plus.

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.
• Monitor team performance, provide coaching and development, and ensure adherence to quality and compliance standards.
• Serve as a subject matter expert for internal and external stakeholders regarding PA criteria, system capabilities, and regulatory requirements.
• Review prior authorization, appeal, and override requests as needed.

Skills

Leadership experience

Pharmacist license

Communication skills

Excel proficiency

Education

PharmD or BPharm

Tools

PA platforms

Data visualization tools

Microsoft Office Suite (Excel)

Job description

Judi Health is seeking a licensed pharmacist with leadership experience to manage a team responsible for developing, implementing, and maintaining clinical criteria and prior authorization system configurations across our benefits platforms.

The ideal candidate will drive evidence-based decision trees, ensure compliant member communications, and partner with cross-functional teams to optimize workflows while adhering to regulatory standards.