Clinical Pharmacy Prior-Authorization Specialist

UCI Health; Orange (CA); On-site; USD 65,000 - 95,000; Full time

Job summary

The PAL Clinical Specialist at UCI Health supports the efficient operation of the prior authorization and utilization management functions, focusing on appeals and exercising clinical judgment in submissions. You will process urgent, routine, pre-service, and retrospective authorization requests with accuracy and timeliness, ensuring compliance with clinical protocols and payer guidelines.

The role requires reviewing documentation, entering data for claims adjudication, and frequent

Qualifications

• Must have current knowledge of drug references, Joint Commission requirements, and other regulatory standards.
• Must demonstrate customer service skills appropriate to the job.
• Graduation from an accredited School of Pharmacy with a Doctor of Pharmacy degree.
• Excellent written and verbal communication skills in English.
• CA Board of Pharmacy Registered Pharmacist licensure in good standing.

Skills

Drug references/regulatory standards

Customer service skills

English communication

CA Board of Pharmacy licensure

Pharmacy degree knowledge

Education

Doctor of Pharmacy (PharmD)

Accredited School of Pharmacy

Job description

The PAL Clinical Specialist at UCI Health supports the efficient operation of the prior authorization and utilization management functions, focusing on appeals and exercising clinical judgment in submissions. You will process urgent, routine, pre-service, and retrospective authorization requests with accuracy and timeliness, ensuring compliance with clinical protocols and payer guidelines.

The role requires reviewing documentation, entering data for claims adjudication, and frequent