Quality Assurance (QA) Pharmacist
Posted on November 28, 2025 (about 3 hours ago)
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 Health17, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and
- Judi17, the industry9s leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform.
Together with our clients, we9re 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 QA Pharmacist will perform routine auditing and monitoring processes to ensure quality, accuracy, and regulatory compliance of coverage requests and appeals. The QA Pharmacist will utilize a strong comprehension of regulatory requirements to ensure success in annual reporting, program audits, and ad hoc audits.
Position Responsibilities:
- Complete monthly utilization management and appeals performance and process audits in alignment with applicable regulations, accreditation standards, and best practices.
- Create and maintain progress reports and audit results in accordance with regulatory/accreditation requirements and internal processes.
- Present audit results to leadership in a timely manner to address issues and ensure adherence to departmental procedures and regulatory/accreditation requirements (CMS, URAC, NCQA).
- Continuously review and remain informed of all regulatory/accreditation requirements and updates impacting the coverage request and appeals processes.
- Respond to inquiries from internal and external stakeholders regarding quality assurance processes, audit results, and compliance policies and procedures.
- Work independently and with team members as warranted by audit assignment.
- Assist in designing and implementing audit tools and programs, creating QA scorecards and guides in collaboration with all department stakeholders.
- Provide ongoing performance feedback, to team leads to ensure consistent performance.
- Assist management in identifying, evaluating, and mitigating operational, and compliance risks.
- Work in collaboration with operational leaders to identify training opportunities and recommend improvements to Work Instructions, Job Aids, and Policy and Procedures to improve performance.
Minimum Qualifications:
- Active, unrestricted, pharmacist license required
- 2+ years of utilization management experience required
- Extensive knowledge of how to operationalize regulatory requirements
- Strong oral and written communication skills required
- Intermediate to advanced Microsoft Excel skills required
- Possess strong analytical skills, attention to detail, quantitative, and problem-solving abilities
- Ability to work independently with minimal supervision, stay productive in a remote, high-volume, metric driven work environment
- Ability to multi-task and collaborate in a team with shifting priorities
Preferred Qualifications:
- Familiarity/experience with URAC and NCQA accreditation requirements
- Utilization management and/or appeals audit experience
- 1+ years of compliance or regulatory experience at a PBM or health plan
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.
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Salary Range
$135,000 - $145,000 USD
Equal Employment Opportunity
All employees are responsible for adherence to the Capital Rx Code of Conduct including the reporting of non-compliance. 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.
Judi Health values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at https://www.judi.health/legal/privacy-policy.
You can apply for this job by clicking the "Apply" button on the job post page or by filling out the application form provided on the page. The application requires submission of basic personal information such as first name, last name, email, phone, resume/CV, cover letter (optional), and confirmation of legal work eligibility in the U.S.
Application Form Includes:
- First Name (required)
- Last Name (required)
- Preferred First Name
- Email (required)
- Phone (required)
- Resume/CV (required)
- Cover Letter (optional)
- LinkedIn Profile
- City and State confirmation (required)
- Authorization to work in the U.S. confirmation (required)
- Visa sponsorship status
- Non-compete or confidentiality agreement status
- Pharmacy degree possession
- Active pharmacist license status
- Disciplinary action history
- Experience with lines of business and funding types
- Experience reviewing and auditing prior authorizations and appeals
More details and submission can be done on the job posting page.