Senior Pharmacist - Prior Authorization Systems Leader

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

Job summary

Judi Health, LLC is seeking a licensed pharmacist leader to manage a team responsible for PA criteria, system configuration, and communications. You will shape utilization management policies and ensure clinical accuracy across configurations.

The role requires a strategic mindset, strong clinical knowledge, and capability to lead high-performing teams in a dynamic environment, with hybrid work options in NYC Denver or Charlotte.

Qualifications

• Active, unrestricted pharmacist license (PharmD or BPharm).
• 5+ years of experience in prior authorization or utilization management, with at least 2 years in a 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.

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

Pharmacist license

Prior authorization

Leadership

Clinical criteria development

PA system configuration

Communication

Education

PharmD or BPharm

Tools

PA platforms

Excel

Data visualization tools

Job description

Judi Health, LLC is seeking a licensed pharmacist leader to manage a team responsible for PA criteria, system configuration, and communications. You will shape utilization management policies and ensure clinical accuracy across configurations.

The role requires a strategic mindset, strong clinical knowledge, and capability to lead high-performing teams in a dynamic environment, with hybrid work options in NYC Denver or Charlotte.