LPN Authorization Coordinator: Utilization & Compliance

Sentara Health Administration, Inc.; Norfolk (VA); On-site; USD 48,000 - 62,000; Full time

Benefits offered by this job

Medical, Dental, Vision plans

Paid Time Off

401k with Employer Match

Tuition Assistance

Student Debt Pay Down

Life Insurance

Disability plans

Job summary

Sentara Health Administration, Inc. seeks an Authorization Coordinator to review clinical data for service authorization, validate member benefits, and ensure data accuracy in claims processing.

The role requires clinical data validation against protocols and regulatory requirements to support proper authorizations. Experience as an LPN, knowledge of managed care and Milliman are valued, with proficiency in Microsoft Office.

Qualifications

• High School Diploma (required).
• Licensed Practical Nurse – LPN (required).
• 3 years of related experience (required).
• Utilization Management experience (preferred).
• Diagnostic Imaging experience (preferred).
• Milliman experience (preferred).

Responsibilities

• Review clinical information to determine service authorization per protocols.
• Validate member benefits and ensure accuracy of enrollment data in the claims system.
• Ensure compliance with regulatory and contractual requirements during review.

Skills

LPN experience

Utilization Management

Diagnostic Imaging

Managed care knowledge

Regulatory compliance

Education

High School Diploma

Licensed Practical Nurse – LPN

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Milliman

Job description

Sentara Health Administration, Inc. seeks an Authorization Coordinator to review clinical data for service authorization, validate member benefits, and ensure data accuracy in claims processing.

The role requires clinical data validation against protocols and regulatory requirements to support proper authorizations. Experience as an LPN, knowledge of managed care and Milliman are valued, with proficiency in Microsoft Office.