Clinical Pharmacy Specialist — Prior Authorization & Appeals

Who We Are UCI Health is one of California's largest academic health systems and the clinical enterprise of the University of California, Irvine. Established on July 1, 1976, UCI Health has grown into a 1,461-bed health system that includes UCI Health - Orange, UCI Health - Irvine, four Community Network hospitals and a growing network of ambulatory care centers across Orange and Los Angeles counties. Who We Are UCI Health is one of California's largest academic health systems and the clinical enterprise of the University of California, Irvine. Established on July 1, 1976, UCI Health has grown into a 1,461-bed health system that includes UCI Health - Orange, UCI Health - Irvine, four Community Network hospitals and a growing network of ambulatory care centers across Orange and Los Angeles counties. As Orange County’s only academic health systems, UCI Health is home to the only National Cancer Institute-designated comprehensive cancer center based in the county, the region’s only American College of Surgeons-verified Level I adult and Level II pediatric trauma center, American College of Emergency Physicians Gold Level 1 Geriatric Emergency Department and a nationally recognized regional burn center verified by the American Burn Association. Powered by UC Irvine, UCI Health serves 5.6 million people across Orange County, western Riverside County and southeast Los Angeles County through excellence in patient care, research and medical education. 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. Required Qualifications What It Takes to be Successful 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: Closing Statement The University of California is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected categories covered by the UC Anti-Discrimination Policy. We are committed to attracting and retaining a diverse workforce along with honoring unique experiences, perspectives, and identities. Together, our community strives to create and maintain working and learning environments that are inclusive, equitable, and welcoming. UCI provides reasonable accommodations for applicants with disabilities upon request. For more information, please contact UCI's Employee Experience Center (EEC) at View email address on click.appcast.io or at View phone number on click.appcast.io, Monday - Friday from 8:30 a.m. - 5:00 p.m. Consideration for Work Authorization Sponsorship Must be able to provide proof of work authorization #J-18808-Ljbffr UC Irvine