Clinical Pharmacy Specialist — Prior Authorization & Appeals

UC Irvine; California (MO); On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

Medical insurance

Vacation time

Retirement plans

Employee discounts

Sick time

Job summary

UCI Health in California seeks a PAL Clinical Specialist to support prior authorization and utilization management, 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, while coordinating with internal teams and health plans to obtain missing information.

Qualifications

• Knowledge of drug references, Joint Commission standards.
• Excellent written and verbal English communications.
• Licensed Pharmacist in California.
• Experience with prior authorization workflows.

Responsibilities

• Process urgent, routine, pre-service and retrospective prior authorizations with accuracy.
• Coordinate with internal departments, providers and health plans to obtain missing information.
• Ensure timely determinations and compliance with clinical protocols.

Skills

Drug references

Regulatory standards

Customer service

Pharmacist degree

English proficiency

CA Pharmacist license

Education

Doctor of Pharmacy (PharmD)

Job description

UCI Health in California seeks a PAL Clinical Specialist to support prior authorization and utilization management, 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, while coordinating with internal teams and health plans to obtain missing information.