Senior PA Systems Pharmacist Leader — Hybrid

Xapply; Charlotte, Denver, New York (NC, CO, NY); Hybrid; USD 155,000 - 180,000; Full time

Job summary

Judi Health, a health technology company, seeks a licensed pharmacist with leadership experience to lead PA criteria development, configuration, and member communications. You will oversee clinical criteria, decision trees, and compliance across the PA process, working with multiple teams to ensure accuracy and efficiency.

The role requires strong clinical knowledge, strategic leadership, and a commitment to high standards.

Qualifications

• Active, unrestricted pharmacist license (PharmD or BPharm required).
• 5+ years of experience in prior authorization or utilization management, with at least 2 in leadership or supervisory roles.
• 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.
• Responsible for adherence to the Capital Rx Code of Conduct, including reporting of noncompliance.
• Position is generally scheduled Monday through Friday during standard business hours. Flexibility is required to support evolving business needs, operational demands, and critical initiatives, which may include work outside of standard hours as necessary.

Skills

Leadership

Clinical criteria development

Utilization management

Communication

Education

PharmD or BPharm

Tools

PA platforms

Microsoft Excel

Data visualization tools

Job description

Judi Health, a health technology company, seeks a licensed pharmacist with leadership experience to lead PA criteria development, configuration, and member communications. You will oversee clinical criteria, decision trees, and compliance across the PA process, working with multiple teams to ensure accuracy and efficiency.

The role requires strong clinical knowledge, strategic leadership, and a commitment to high standards.