Judi Health
health technology
UtilizationManagementPharmacist(Temp,Temp-to-hire)
Neural analysis suggests this role is
optimal for Mid+ candidates.
“Utilization Management Pharmacist (Temp, Temp-to-hire) at Judi Health. Skills: prior authorization, medication use, clinical decision-making, regulatory compliance. Review and make timely, evidence-based decisions on prior authorizations, appeals, and override requests using clinical guidelines and benefit criteria.. Ensure compliance with federal, state, and internal regulations across Commercial, Exchange, Medicare, and Medicaid plans.”
What You'll Achieve.
promoting safe, effective, and appropriate medication use; timely, evidence-based decisions on prior authorizations, appeals, and override requests; Ensure compliance with federal, state, and internal regulations; protect patient privacy and data security
Industry & Context.
clinical decision-making; review prior authorization requests; appeals; override requests
Availability to work after hours, weekends, and holidays on a rotating schedule
What They're Looking For.
Must Have
Minimum of 6 months to a year of prior authorization experience, Active, unrestricted, pharmacist license, Bachelor's or Doctor of Pharmacy degree, Minimum of 2 years of pharmacy practice experience
Nice to Have
Call center experience
What You'll Do.
Review and make timely
evidence-based decisions on prior authorizations
and override requests using clinical guidelines and benefit criteria.
Ensure compliance with federal
and internal regulations across Commercial
Accurately document clinical decisions and maintain thorough records in accordance with regulatory and accreditation (URAC/NCQA) utilization review standards.
empathetic support to members
and pharmacies by responding to clinical inquiries via phone
demonstrating professionalism
and a patient-centered approach.
Stay current with clinical prescribing guidelines
and regulatory changes
and apply them to daily responsibilities.
Follow all internal procedures
and HIPAA guidelines to protect patient privacy and data security.
Identify and report potential fraud
Support training and development of new and existing team members as needed.
Assist leadership with special projects
and operational initiatives
How You'll Work.
Team & Collaboration
collaborative environment; Support training and development of new and existing team members as needed.; Assist leadership with special projects, process improvements, and operational initiatives
Communication Scope
communication; responding to clinical inquiries via phone; empathetic support
Process & Methodology
special projects, process improvements, operational initiatives
Full Job Description
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, and Judi®, 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. Position Summary: The Clinical Care Pharmacist plays a vital role in promoting safe, effective, and appropriate medication use. This position is responsible for reviewing prior authorization requests, supporting clinical programs, and providing expert guidance to members, providers, and pharmacies. The role combines clinical decision-making with a strong focus on service excellence in a fast-paced, collaborative environment. Position Responsibilities: Review and make timely, evidence-based decisions on prior authorizations, appeals, and override requests using clinical guidelines and benefit criteria. Ensure compliance with federal, state, and internal regulations across Commercial, Exchange, Medicare, and Medicaid plans. Accurately document clinical decisions and maintain thorough records in accordance with regulatory and accreditation (URAC/NCQA) utilization review standards. Provide clear, empathetic support to members, prescribers, and pharmacies by responding to clinical inquiries via phone, demonstrating professionalism, active listening, and a patient-centered approach. Stay current with clinical prescribing guidelines, internal policies, and regulatory changes, and apply them to daily responsibilities. Fo
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