UM Medication Prior Authorization Nurse (Remote)
Seven Counties Services
Summary
Seven Counties Services is Kentucky's leading Community Mental Health Center, providing comprehensive behavioral health services across seven counties in the Louisville region. Founded in 1978, the organization offers a full spectrum of mental health services, substance abuse treatment, and intellectual and developmental disabilities support to children, adults, and families. With over 1,500 professionals operating from 30+ offices, Seven Counties Services serves approximately 30,000 individuals annually, maintaining full accreditation from The Joint Commission. The organization specializes in child and family behavioral health, adult behavioral health, developmental services, substance abuse and addiction treatment, and prevention services. As a nationally recognized provider, Seven Counties Services operates with a trauma-informed approach and provides 24/7 crisis support through the 988 hotline, ensuring accessible care regardless of diagnosis or insurance status. The organization has been recognized as a Top Workplace in the Greater Louisville Area and maintains strong community partnerships to deliver integrated care that addresses both mental and physical health needs.
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 data and trends to medical leadership around medication denials and approvals.
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
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
Company overview
Seven Counties Services is Kentucky's leading Community Mental Health Center, providing comprehensive behavioral health services across seven counties in the Louisville region. Founded in 1978, the organization offers a full spectrum of mental health services, substance abuse treatment, and intellectual and developmental disabilities support to children, adults, and families. With over 1,500 professionals operating from 30+ offices, Seven Counties Services serves approximately 30,000 individuals annually, maintaining full accreditation from The Joint Commission. The organization specializes in child and family behavioral health, adult behavioral health, developmental services, substance abuse and addiction treatment, and prevention services. As a nationally recognized provider, Seven Counties Services operates with a trauma-informed approach and provides 24/7 crisis support through the 988 hotline, ensuring accessible care regardless of diagnosis or insurance status. The organization has been recognized as a Top Workplace in the Greater Louisville Area and maintains strong community partnerships to deliver integrated care that addresses both mental and physical health needs.