Authorization Coordinator / Licensed Practical Nurse (LPN) for LTSS/ Medicaid - Remote in Virginia
About The Position
Sentara Health Plans is hiring an Authorization Coordinator / Licensed Practical Nurse (LPN) for LTSS/ Medicaid - Remote in Virginia. This is a full-time, permanent position with standard working hours of 8am to 5pm EST, Monday through Friday. The role is remote and based in Virginia. The primary responsibility is to review clinical information from healthcare providers to ensure it is sufficient for authorizing services. This involves analyzing clinical data against protocols, validating member benefits, and confirming the accuracy of insurance enrollment information. The position requires knowledge of managed care contracting, clinical protocols, clinical review requirements, and regulatory compliance for various payer types. Accurate data entry into the claims system for payment processing is also a key duty.
Requirements
- HS - High School Grad or Equivalent REQUIRED
- Licensed Practical Nurse (LPN) - Nursing License - Compact/Multi-State License REQUIRED
- 3 years of related clinical experience as an LPN, such as experience in a physician office, acute care, managed care or clinic setting REQUIRED
Nice To Haves
- Authorizations or LTSS or Medicaid experience highly preferred
Responsibilities
- 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.
- 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.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
