Utilization Management Pharmacist (temp-to-hire)

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, 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.

The Utilization Management 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.

• →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.
• →Follow all internal procedures, job aids, and HIPAA guidelines to protect patient privacy and data security.
• →Identify and report potential fraud, waste, and abuse.
• →Support training and development of new and existing team members as needed.
• →Assist leadership with special projects, process improvements, and operational initiatives

• Minimum of 6 months to a year of prior authorization or utilization management experience
• Active, unrestricted, pharmacist license
• Bachelor’s or Doctor of Pharmacy degree
• Minimum of 2 years of pharmacy practice experience
• Experience in managed care or pharmacy benefit management (PBM)
• Strong communication, writing, and organizational skills
• Ability to manage multiple priorities in a high-volume, metric-driven environment
• Availability to work after hours, weekends, and holidays on a rotating schedule

• Call center experience

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.