PAL Clinical Specialist - Pharmacy Administration - FT Variable Shift

University of California, Irvine • Orange, CA

1d

About The Position

Position Summary:
The PAL Clinical Specialist supports the efficient operation of the prior authorization and utilization management functions with a focus on appeals and exercising clinical judgment in submissions within UCI Health. The incumbent will process urgent, routine, pre-service, and retrospective authorization requests with accuracy and timeliness, ensuring compliance with clinical protocols, payer guidelines, and regulatory requirements. The position requires the use of various business applications to review documentation, analyze requests, and enter prior authorization data for claims adjudication. The role involves frequent communication with internal departments, providers, and health plans to obtain missing information, clarify requests, and ensure timely determination notifications. The PAL Clinical Specialist contributes to the delivery of outstanding service, operational efficiency, and high-quality patient care by supporting the authorization workflow from intake through resolution.

Requirements

• 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

Nice To Haves

• Possession of the legal requirements for the practice of pharmacy as determined by the CA Board of Pharmacy
• Current BLS or ACLS upon hire
• Ability to maintain a work pace appropriate to the workload

Benefits

• medical insurance
• sick and vacation time
• retirement savings plans
• access to a number of discounts and perks

What This Job Offers

• Job Type: Full-time
• Education Level: Ph.D. or professional degree