Medication Prior Authorization Nurse

Job not on LinkedIn

🔥 11 minutes ago

🐎 Kentucky – Remote

🐎 Kentucky – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 10%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Seven Counties Services

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 Non-profit

Healthcare • Healthcare Insurance • Non-profit

Seven Counties Services is a leading Community Mental Health Center and behavioral health services provider in Kentucky, serving individuals and families across Bullitt, Henry, Jefferson, Oldham, Shelby, Spencer, and Trimble counties. They offer a wide range of services including mental health support, addiction recovery programs, developmental services, and crisis stabilization. The organization is committed to providing quality care and health services, ensuring a positive approach tailored to individual needs, regardless of background or financial status. Additionally, Seven Counties Services emphasizes equity, diversity, and inclusion in their programs and initiatives, continually striving to improve the lives of those they serve.

📋 Description

• Review cases and apply medical criteria to evaluate and submit authorizations to MCOs, Medicare, and commercial insurance companies based on medical necessity • Collaborate with site providers, nurses, pharmacies, and insurance to advocate for and meet client needs • Interpret and communicate medication denials with site providers, offering guidance and education • Communicate with site providers and nurses to provide ongoing education about medication formulary requirements • Conduct chart audits for medical necessity, quality, and compliance standards • Review utilization management reports for outstanding and expiring authorizations • Document and maintain accurate records of all communications • Maintain a centralized knowledge base of formularies and prior authorization requirements • Provide data and trends to medical leadership regarding medication denials and approvals • Exercise principle-centered leadership focused on customer service responsiveness and continuous quality improvement

🎯 Requirements

• Completion of certified nursing program • Five plus years of clinical experience • At least one year of utilization case management preferred • Kentucky Board of Nursing active and unencumbered LPN or RN license • Greater Louisville candidates only will be considered • Knowledge of policies and procedures related to safety management and Joint Commission standards • Ability to review medical criteria and evaluate medication prior authorizations • Ability to communicate medication denials and provide guidance and education • Ability to conduct chart audits for medical necessity, quality, and compliance standards • Ability to maintain accurate records and centralized knowledge of formularies and prior authorization requirements

🏖️ Benefits

• Remote work arrangement

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