Appeals Pharmacist
Judi Health(1 month ago)
About this role
A Pharmacist reviewer at Judi Health is responsible for overseeing clinical coverage determinations and appeals for lines of business such as Commercial and Medicare, ensuring decisions align with clinical criteria and medical necessity. The role supports client expectations for efficiency and quality, requires adherence to regulatory and company policies, and operates in a remote, metric-driven environment.
Required Skills
- Appeals Review
- Clinical Assessment
- Phone Communication
- Medical Collaboration
- Guideline Interpretation
- Peer Review
- Literature Evaluation
- Documentation
- Prior Authorization
- Quality Management
+4 more
Qualifications
- Active Unrestricted Pharmacist License
- 1+ Years Prior Authorization Experience
About Judi Health
judi.healthJudi Health and Capital Rx deliver unified pharmacy and medical benefit management for employers, unions, health systems, and government programs. Capital Rx provides transparent, member-focused PBM solutions while Judi Health’s Judi® platform integrates pharmacy, medical, vision, and dental benefits into a single coordinated system. Together they support millions of plan members, aiming to simplify benefit administration, improve member experience, and control costs.
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