Senior PA Systems Pharmacist Leader

Capital Rx Inc.; Denver (CO); On-site; USD 155,000 - 180,000; Full time

Job summary

Judi Health seeks a licensed pharmacist with leadership experience to manage a team responsible for PA criteria development, system configuration, and letter template management. You will oversee clinical criteria creation, decision trees, and member communications to ensure compliance, efficiency, and clinical accuracy.

The role requires strategic thinking, strong clinical knowledge, and a track record of leading high-performing teams in a dynamic environment.

Qualifications

• Active, unrestricted pharmacist license (PharmD or BPharm)
• 5+ years in prior authorization or utilization management, with at least 2 years in a leadership 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, especially Excel; 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 language.
• Ensure timely and accurate formulary updates, new drug reviews, and regulatory changes across all lines of business.
• Collaborate with cross-functional teams to optimize workflows and ensure alignment.
• Drive continuous improvement in PA system configuration, including automation and self-service tools.
• Monitor team performance, provide coaching and development, and ensure quality and compliance.
• Serve as a subject matter expert for PA criteria, system capabilities, and regulatory requirements.
• Review PA, appeal, and override requests as needed.
• Adhere to Code of Conduct, reporting noncompliance.
• Typical schedule is Monday–Friday with possible after-hours as needed.

Skills

Leadership

PA criteria development

Utilization management

Clinical knowledge

Communication

Excel

PA platforms

Data visualization tools

Regulatory requirements

Letter template management

Education

PharmD or BPharm

Tools

PA platforms

Excel

Data visualization tools

Job description

Judi Health seeks a licensed pharmacist with leadership experience to manage a team responsible for PA criteria development, system configuration, and letter template management. You will oversee clinical criteria creation, decision trees, and member communications to ensure compliance, efficiency, and clinical accuracy.

The role requires strategic thinking, strong clinical knowledge, and a track record of leading high-performing teams in a dynamic environment.