UM Medication Prior Authorization Nurse (Remote) Greater Louisville candidates only will be con sidered

Job Description:

ESSENTIAL JOB FUNCTIONS

• Reviews cases and applies medical criteria to evaluate and submit authorizations to MCO’s, Medicare and commercial insurance companies based on medical necessity.
• Collaborates with site providers and nurses, pharmacies and insurance to advocate and meet the needs of the client.
• Interprets and communicates medication denials with site providers offering guidance and education.
• Communicates with site providers and nurses to provide ongoing education around medication formulary requirements.
• Conducts chart audits for medical necessity, quality and compliance standards.
• Reviews UM reports for outstanding and expiring authorizations to be completed.
• Documents and maintains accurate records of all communications.
• Maintains a centralized knowledge base around formularies and prior authorization requirements.
• Provides date and trends to medical leadership around medication denials and approvals.

The intent of this job description is to provide a representative summary of the major duties and responsibilities performed by incumbents of this job. Incumbents may be requested to perform job-related tasks other than those specifically presented in this description.

EDUCATION

• Completion of certified nursing program

EXPERIENCE

• Five plus years of clinical experience.
• At least one year of utilization case management preferred.

REQUIREMENTS

• Kentucky Board of Nursing active and unencumbered LPN or RN license

PHYSICAL DEMANDS

• Occasional minor discomforts from continual exposure to video display terminal

Within the bounds of their respective job descriptions, all staff are expected to exercise principle-centered leadership, focused on customer service responsiveness, with a continuous quality improvement orientation. Additionally, all staff are expected to develop a working knowledge of and follow all policies and procedures related to safety management and other Joint Commission standards.

Time Type:

About Us

Seven Counties is the provider of choice for mental and behavior health services in and around the Louisville Metro.

Over 1,400 employees work in 25+ locations throughout Bullitt, Henry, Jefferson, Oldham, Shelby, Spencer and Trimble counties; making sure that the 31,000 people we serve annually have the best chance of living their best lives.

At Seven Counties, we give our staff the opportunity to do what they do best with continued training, effective mentoring and competitive salaries and benefits.

In an effort to protect our employees, clients and community, we require the COVID and Influenza vaccinations for all employees.