Authorization Coordinator/Licensed Practical Nurse (LPN) - Remote in Virginia
City/State
Norfolk, VAWork Shift
First (Days)Overview:
Sentara Health Plans is hiring a Authorization Coordinator/Licensed Practical Nurse (LPN) - Remote in Virginia
Status: Full-time, permanent position (40 hours)
Standard work hours: 8am to 5pm EST, M-F
Location: Remote in Virginia
Job Description Summary:
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.
Education:
HS - High School Grad or Equivalent REQUIRED; LPN Diploma or Associate Degree in Practical Nursing preferred
Certification/Licensure:
Licensed Practical Nurse (LPN) - Nursing License - Compact/Multi-State License REQUIRED
Experience:
Related experience- 3 years
Health Plan OR Utilization Management experience preferred
JIVA and Milliman Care Guidelines (MCG) experience preferred
Related clinical experience as an LPN, such as experience in a physician office, acute care, managed care or clinic setting, and prior authorization
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!
To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-96211
#Indeed
Talroo – Health Plan
Managed Care, MCO, Health Plan, Healthcare, Remote, Virginia, Virginia Beach, Clinical, LPN, License Practical Nurse, Utilization Management, Utilization Review, Medical Necessity, JIVA, Milliman
•Legal Resources Plan
•Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.
Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
In support of our mission “to improve health every day,” this is a tobacco-free environment.
For positions that are available as remote work, Sentara Health employs associates in the following states:
Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.