Virginia Beach, VA
Jan 08, 2019
Feb 14, 2019
Full Time

Optima Health is seeking an experienced LPN to serve in the role as an Authorization Coordinator in Virginia Beach, VA. This is a full-time, non-remote position.

In this position you will ensure advanced imaging, outpatient and medical benefit high cost medications, durable medical equipment and home health services are reviewed for medical necessity and service authorization or denial recommendations. Serves as primary nurse responsible for managing and validating provider portal authorizations for accuracy, medical appropriateness and compliance accuracy. Ensures compliance with NCQA, Department of Labor, OHP provider contracts,

Optima Health is a service of Sentara Healthcare, so joining Optima is joining the Sentara Healthcare family. Optima Health offers a full suite of commercial health insurance products including employee-owned and employer-sponsored plans, as well as Individual and Family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees. We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services.

As a nationally recognized provider of health plan coverage and innovative wellness programs, we live our mission "to improve health everyday." This same commitment and dedication directs our philosophy as an employer. When you join Optima Health, you will experience our deep passion for heal and service excellence while benefiting from a culture of opportunity, learning, career growth, and support --every day.

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!

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.


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 Level
Trade School Graduate

Required: Related - 3 years

Preferred: None, unless noted in the "Other" section below

None, unless noted in the "Other" section below

None, unless noted in the "Other" section below

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