Senior Manager, Prior Authorization Systems Pharmacist

Location: Hybrid (Local to NYC area, Denver CO or Charlotte NC)

About the role

Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single, secure platform. By delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels. At Judi Health, we're deploying the infrastructure our country needs to deliver the healthcare we all deserve. We are the intelligence platform powering benefits plans for millions of Americans and proudly leading the next generation of care.

We are seeking a licensed pharmacist with leadership experience to manage a team responsible for the development, implementation, and maintenance of clinical criteria and prior authorization (PA) system configurations. This role will oversee the creation of utilization management policies, decision tree logic, and member-facing communications to ensure compliance, efficiency, and clinical accuracy. The ideal candidate brings a strategic mindset, strong clinical knowledge, and a passion for leading high-performing teams in a dynamic environment.

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.

Qualifications

• Active, unrestricted pharmacist license (PharmD