Clinical Pharmacy Prior-Authorization Specialist

University-of-California,-Irvin; Orange (CA); On-site; USD 110,000 - 150,000; Full time

Job summary

UCI Health is seeking a PAL Clinical Specialist to support prior authorization and utilization management with emphasis on appeals and clinical judgment. The role processes urgent, routine, pre-service, and retrospective authorizations, ensuring compliance with clinical protocols and payer guidelines.

The position requires frequent communication with internal teams, providers, and health plans, accurate data entry, and timely determinations to deliver high-quality patient care and operational

Qualifications

• Knowledge of drug references and regulatory standards.
• Demonstrated customer service skills.
• PharmD degree from an accredited school.

Responsibilities

• Process urgent, routine, pre-service and retrospective prior authorization requests with accuracy.
• Communicate with internal departments, providers and health plans to obtain missing information.
• Support the authorization workflow from intake through resolution to ensure timely determinations.

Skills

Regulatory knowledge

Customer service

English communication

Education

Doctor of Pharmacy (PharmD)

Job description

UCI Health is seeking a PAL Clinical Specialist to support prior authorization and utilization management with emphasis on appeals and clinical judgment. The role processes urgent, routine, pre-service, and retrospective authorizations, ensuring compliance with clinical protocols and payer guidelines.

The position requires frequent communication with internal teams, providers, and health plans, accurate data entry, and timely determinations to deliver high-quality patient care and operational