Prior Authorization Systems Technician

About Judi HealthJudi 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. To learn more, visit www.judi.health.Location: Remote (For Non-Local) or Hybrid (Local to New York, NY, Charlotte, NC or Denver, CO area)Position SummaryResponsible 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 environmentRequired 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 preferredBase Salary: New York, NY (hybrid) $75,000 - $80,000Denver, CO (hybrid) $75,000 - $80,000Charlotte, NC (hybrid) $75,000 - $80,000Remote - $75,000 - $80,000 (final salary within this range is determined by the candidate's geographic location and applicable market tier)This range represents the low and high end of the anticipated base salary range. The actual base salary wil