Licensed Practical Nurse (LPN) Authorizations
Licensed Practical Nurse (LPN) Pre-Authorizations Coordinator to work at our Norfolk, VA office.
This is an office-based position for an experienced LPN with a minimum of 3 years of related clinical experience in a physician office, acute care setting, managed care or clinic . Previous authorizations experience is a plus.
Optima Health Community Care is a Commonwealth Coordinated Care Plus (CCC Plus) Medicaid plan for many older people and those with disabilities. CCC Plus is a Medicaid managed care program through the Virginia Department of Medical Assistance Services (DMAS).
With Optima Health Community Care, members benefit from an individualized, fully-integrated program with a state-wide network of providers. As an Optima Health Community employee, you will join a care team committed to providing customized and personalized support and services in the community that our members can count on. Optima Health is a service of Sentara Healthcare, so joining Optima is joining the Sentara Healthcare family.
Sentara employees strive to make our communities healthier places to live. We're setting the standard for medical excellence within a vibrant, creative, and highly productive workplace. For more information about our employee benefits, CLICK HERE!
Join our team, where we are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, growth!
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.
Trade School Graduate
Required: Related - 3 years
None, unless noted in the “Other” section below
Related clinical experience as a Medical Assistant or LPN experience in a physician office, acute care, managed care or clinic setting. Active license required as applicable.
Keyword: LPN, Licensed Practical Nurse, health plan, health insurance, authorizations, managed care, office setting