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Open nowPosted 3 days ago

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

sevencounties124 open roles

Where
Louisville, Kentucky
Work mode
Remote
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Your applicationOpen nowUM Medication Prior Authorization Nurse (Remote) Greater Louisville candidates only will be con sideredsevencounties · Louisville, Kentucky

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The clock on this job

Early applications get read.

13.9% of postings close within 7 days. Measured by our own scanner across the market. sevencounties postings stay open a median of 22 days.

Share of postings closed within
  1. 2.2%1 day
  2. 4.7%3 days
  3. 13.9%7 days
  4. 22.4%14 days
  5. 38.1%30 days
  6. 59.0%60 days
This job: posted 3 days ago

sevencounties median: 22 days open

The posting

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:

Full time

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