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Quality Assurance (QA) Pharmacist

Capital Rx, Inc.

Job Overview

Location

Remote

Job Type

Full-time

Full Job Description

📋 Description

• The Quality Assurance (QA) Pharmacist ensures the accuracy, quality, and regulatory compliance of coverage requests and appeals through routine auditing and monitoring, playing a critical role in maintaining trust in healthcare systems.
• Day-to-day responsibilities include completing monthly utilization management and appeals audits, creating progress reports, presenting findings to leadership, staying current on regulatory updates (CMS, URAC, NCQA), responding to stakeholder inquiries, assisting in audit tool design, providing performance feedback, identifying compliance risks, and collaborating on process improvements.
• The role is part of Judi Health, an enterprise health technology company that includes Capital Rx (a public benefit PBM), Judi Health™ (health benefit management), and Judi® (the Enterprise Health Platform), all working to rebuild trust in U.S. healthcare through scalable, secure technology.
• The QA Pharmacist will deepen expertise in healthcare regulatory compliance, utilization management, and audit processes while contributing to organizational risk mitigation and process excellence in a remote, metric-driven environment.

🎯 Requirements

• Active, unrestricted pharmacist license
• 2+ years of state regulatory and audit utilization management experience at a PBM or health plan
• Strong oral and written communication skills
• Intermediate to advanced Microsoft Excel skills
• Ability to work independently with minimal supervision in a high-volume, remote setting
• Familiarity with URAC and NCQA accreditation requirements (preferred)

🏖️ Benefits

• Salary range of $135,000–$145,000 USD
• Remote work flexibility
• Opportunity to contribute to rebuilding trust in U.S. healthcare through innovative health technology
• Equal employment opportunities and commitment to diversity, equity, and inclusion
• Privacy-conscious application process with data retention for future consideration

Skills & Technologies

Remote

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Capital Rx, Inc.

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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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