Prior Authorization Systems Technician

About Judi Health Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including: Judi Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers,Judi Health™, which offers full-service health benefit management solutions to employers, TPAs, and health plans, andJudi®, the industry’s leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform. Together with our clients, we’re rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit www.judi.health. Location: Hybrid (Local to New York, NY, Charlotte, NC or Denver, CO area) Position Summary Responsible for the maintenance, configuration, and validation of prior authorization (PA) criteria, decision trees, and communication templates within the PA system. Supports accurate translation of clinical requirements into system logic through routine updates, testing, and quality checks. Partners with pharmacists and cross-functional teams to ensure data integrity, resolve issues, and maintain efficient, compliant PA operations. Position Responsibilities: Evaluate and operationalize weekly formulary and utilization management (UM) updates, including criteria changes, product additions, and retirementsMaintain and configure prior authorization (PA) criteria, rules, and source documentation within the PA platform, ensuring alignment with clinical and formulary intentExperience creating or maintaining prior authorization decision trees, rules engines, or clinical workflows strongly preferredAbility to interpret clinical guidelines and translate them into structured logic or system configurationsExperience documenting clinical rationale or supporting materials for utilization management criteria preferredPerform structured validation and quality assurance (QA) of criteria builds, letter templates, and system configurations prior to deploymentPartner with Formulary Operations and Clinical teams to identify and resolve discrepancies in criteria logic, coding, or documentationSupport new drug-to-market implementations, including analysis and updates for GPI, NDC, and other product identifiers impacting existing authorizationsMaintain and enhance letter templates and automated communications to ensure regulatory compliance and operational consistencyExecute and support batch load testing, regression testing, and release validation for system updates and enhancementsAct as a subject matter resource for PA criteria setup, troubleshooting issues, and answering internal inquiries from operations, pharmacists, and business partnersMonitor and triage system or configuration issues, escalating appropriately and partnering with IT/vendor teams for resolutionConduct intake and pre-review preparation of PA cases by validating member, provider, and clinical information against guideline requirementsProactively obtain and organize clinical documentation to ensure completeness and readiness for pharmacist or clinician reviewCollaborate cross-functionally with Clinical, Operations, IT, and Business teams to support system improvements, process optimization, and implementation initiativesIdentify opportunities for workflow efficiency, automation, and data quality improvement within the PA processAdapt quickly to shifting priorities and support multiple concurrent initiatives in a fast-paced environment Required Qualifications: 4+ years of pharmacy technician experience in a PBM, health plan, or clinical pharmacy environmentDemonstrated experience working with prior authorization systems, UM criteria, or clinical rule configurationNational Certified Pharmacy Technician (CPhT) certification requiredStrong understanding of prior authorization workflows, clinical guidelines, and formulary managementExperience supporting system testing (UAT, regression, or configuration validation) preferredHigh attention to detail with a focus on data accuracy and configuration qualityAbility to troubleshoot system or workflow issues and communicate clearly with technical and non-technical stakeholdersProficiency in Microsoft Excel and Word; ability to work with structured data and perform basic analysis (e.g., validation, comparisons, tracking updates)Experience working cross-functionally with clinical, operational, and/or IT teams preferredBachelor’s degree or equivalent combination of education and experience preferredDepending on the changing needs of the business, you may be required to work rotating weekends and/ or participate in an on-call schedule in the future. This range represents the low and high end of the anticipated base salary range. The actual base salary will depend on several factors such as: experience, knowledge, and skills, and location of the job. Nothing in this position description restricts management’s right to assign or reassign duties and responsibilities to this job at any time. Benefits Judi Health provides all full-time and part-time benefit-eligible employees with the ability to elect medical and pharmacy coverage, dental insurance, vision insurance, accidental injury insurance, critical illness insurance, hospital indemnity insurance, and flexible spending accounts. Full-time employees also have access to a health savings account, voluntary life insurance, and voluntary accidental death and dismemberment insurance for themselves and their eligible dependents. Judi Health provides full-time employees with the following benefits at no cost to the employee: basic life insurance, basic accidental death and dismemberment insurance, paid time off, sick time, holidays, short-term disability, long-term disability, an employee assistance program, and a wellness program. Full-time employees are also eligible for a 401(k) plan with company match after one year of full-time employment. About Judi Health Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including: Capital Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers,Judi Health™, which offers full-service health benefit management solutions to employers, TPAs, and health plans, andJudi®, the industry’s leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform. Together with our clients, we’re rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. New York, NY Salary Range: $75,000 USD - $80,000 USD Denver, CO Salary Range: $75,000 USD - $80,000 USD Charlotte, NC Salary Range: $75,000 USD - $80,000 USD All employees are responsible for adherence to the Judi Health Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals. We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at https://www.judi.health/legal/privacy-policy.