Your Role on the Team

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.

What It Takes to be Successful

Required 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

Preferred Qualifications:

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

Licenses and Certifications:

Registered Pharmacist

Education:

Total Rewards

We offer a wealth of benefits to make working at UCI even more rewarding. These benefits may include medical insurance, sick and vacation time, retirement savings plans, and access to a number of discounts and perks. Please utilize the links listed here to learn more about our compensation practices and benefits.

Conditions of Employment:

The University of California, Irvine (UCI) seeks to provide a safe and healthy environment for the entire UCI community. As part of this commitment, all applicants who accept an offer of employment must comply with the following conditions of employment:

• Background Check and Live Scan
• Employment Misconduct*
• Legal Right to Work in the United States
• Vaccination Policies
• Smoking and Tobacco Policy
• Drug Free Environment

*Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts a conditional offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; received notice of any allegations or are currently the subject of any administrative or disciplinary proceedings involving misconduct; have left a position after receiving notice of allegations or while under investigation in an administrative or disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer.

The following additional conditions may apply, some of which are dependent upon business unit or job specific requirements.

• California Child Abuse and Neglect Reporting Act
• E-Verify
• Pre-Placement Health Evaluation

Details of each policy may be reviewed by visiting the following page: https://hr.uci.edu/new-hire/conditions-of-employment.php

Consideration for Work Authorization Sponsorship

Must be able to provide proof of work authorization