Job Overview
Location
Remote
Job Type
Full-time
Category
HR & Recruiting
Date Posted
April 21, 2026
Full Job Description
đź“‹ Description
- • Lead and manage a team of clinical pharmacists and technicians focused on prior authorization and appeals processes to ensure efficient and compliant utilization management.
- • Develop and maintain policies, procedures, and clinical criteria for utilization management, leveraging data to optimize staffing and workflow efficiency.
- • Oversee quality management, regulatory compliance, and performance reporting for prior authorization activities, including URAC-aligned quality improvement initiatives.
- • Drive recruitment, onboarding, training, and professional development of pharmacy staff while resolving escalated client and clinical partner issues.
- • Collaborate with leadership on strategic initiatives, RFIs, RFPs, and contract management with external vendors and Independent Review Organizations.
- • Perform hands-on clinical pharmacy duties including prior authorization reviews, appeals, override requests, and member/provider education calls.
- • Operate in a remote, fast-paced environment with flexibility for occasional on-call responsibilities and adjusted hours based on business needs.
- • Contribute to Capital Rx’s mission of transforming pharmacy benefits through innovation, technology, and data-driven strategies that reduce costs and improve patient outcomes.
- • Work within a mission-driven, growing PBM that is part of Judi Health, an enterprise health technology company rebuilding trust in healthcare through its Enterprise Health Platform (Judi®).
- • Gain leadership experience in a high-impact role shaping utilization management strategy while advancing clinical and operational expertise in commercial and Medicare Part D landscapes.
🎯 Requirements
- • Active, unrestricted pharmacist license
- • Bachelor of Pharmacy or Doctor of Pharmacy degree
- • 4+ years of prior authorization experience at a PBM or health plan
- • 3+ years of leadership experience (preferred)
- • Experience with Commercial and Medicare Part D lines of business (preferred)
- • Strong written and oral communication skills
- • Proficiency in Microsoft Office Suite, especially Excel and PowerPoint
- • Ability to thrive in a fast-paced environment with shifting priorities
- • Strong attention to detail and commitment to high-quality work
🏖️ Benefits
- • Competitive base salary range of $155,000–$170,000 USD
- • Remote work flexibility
- • Opportunity to lead and grow a clinical pharmacy team
- • Exposure to end-to-end utilization management and prior authorization processes
- • Involvement in quality improvement and URAC compliance initiatives
- • Access to innovative health technology platforms (Judi® Enterprise Health Platform)
- • Professional development and training support for staff and self
- • Work at a mission-driven, fast-growing PBM focused on transforming healthcare
- • Comprehensive health and wellness benefits (implied by industry standard and company focus on health)
- • Collaborative, inclusive workplace committed to diversity and equal opportunity
Skills & Technologies
Remote
Degree Required
About Capital Rx, Inc.
Capital Rx is a full-service pharmacy benefit manager and healthcare technology company that modernizes drug pricing and claims processing. Its cloud-based platform, JUDI, connects every aspect of the pharmacy ecosystem, enabling transparent, pass-through pricing and real-time analytics. The company administers formularies, rebates, and networks for employers, health plans, and government entities, aiming to lower prescription costs and improve patient outcomes.
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