UM Medication Prior Authorization Nurse (Remote) Greater Louisville candidates only will be con sidered
- Location
- Louisville, KY (Remote)
- Listed
- Today
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.
Additional information
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
Additional information
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
From Seven Counties Services's careers page, first listed on Rolev.ai on November 15, 2026. Rolev.ai is not the employer.
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Common questions
Where is the UM Medication Prior Authorization Nurse (Remote) Greater Louisville candidates only will be con sidered job at Seven Counties Services located?
Yes, this UM Medication Prior Authorization Nurse (Remote) Greater Louisville candidates only will be con sidered opening at Seven Counties Services is listed as Louisville, KY (Remote). Always check Seven Counties Services's application page for specific state eligibility or relocation policies.
How do I apply for the UM Medication Prior Authorization Nurse (Remote) Greater Louisville candidates only will be con sidered position at Seven Counties Services?
This listing links directly to Seven Counties Services's Workday application page. You can apply directly on Seven Counties Services's site, or use Rolev.ai to check your resume fit, generate a zero-hallucination tailored resume and cover letter for this posting, and autofill the Workday application form in 1 click with the Rolev.ai Chrome extension. You always review the form and press Submit yourself.