Authorization Coordinator/Licensed Practical Nurse (LPN) - Remote in Virginia

Sentara Health

1d • Remote

About The Position

Responsible for review of clinical information received from Physicians and other Clinical providers ensuring clinical data is substantial enough to authorize services. Analyzes clinical information to ensure the services requested are authorized according to clinical protocols. Responsible for validation of member benefits for the services requested. Validates accuracy of insurance enrollment information in the system prior to authorizing services. Requires knowledge of managed care contracting, clinical protocols and clinical review requirements. Requires knowledge of regulatory and compliance requirements for government payers, self funded and commercial payers. Ensures appropriate and accurate information is entered into claims system for processing of payment. Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees. Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals. We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services—all to help our members improve their health. Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth. Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!

Requirements

• HS - High School Grad or Equivalent
• Licensed Practical Nurse (LPN) - Nursing License - Compact/Multi-State License
• Related clinical experience as an LPN, such as experience in a physician office, acute care, managed care or clinic setting, and prior authorization

Nice To Haves

• LPN Diploma or Associate Degree in Practical Nursing
• 3 years Health Plan OR Utilization Management experience
• JIVA and Milliman Care Guidelines (MCG) experience

Responsibilities

• Review of clinical information received from Physicians and other Clinical providers ensuring clinical data is substantial enough to authorize services.
• Analyzes clinical information to ensure the services requested are authorized according to clinical protocols.
• Responsible for validation of member benefits for the services requested.
• Validates accuracy of insurance enrollment information in the system prior to authorizing services.
• Ensures appropriate and accurate information is entered into claims system for processing of payment.

Benefits

• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to $10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long-Term, Short-Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down – $10,000
• Reimbursement for certifications and free access to complete CEUs and professional development
• Pet Insurance
• Legal Resources Plan
• Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees