LPN Authorization Coordinator | Utilization Review

sentara; Norfolk (VA); On-site; USD 37,000 - 55,000; Full time

Benefits offered by this job

Medical, Dental, Vision plans

401k/403B with Employer Match

Paid Time Off and Sick Leave

Tuition Assistance

Job summary

Sentara Health in Norfolk, VA is seeking an Authorization Coordinator to review clinical information from physicians and other providers to determine if data supports service authorization. You will ensure data aligns with clinical protocols and validate member benefits for the requested services.

The role requires data accuracy in enrollment systems and entering information into the claims system. LPN experience in physician offices or acute care is preferred for this role.

Qualifications

• High School Diploma required.
• Licensed Practical Nurse (LPN) certification required.
• 3 years of related experience required.
• Utilization Management, diagnostic imaging, Milliman experience preferred.
• Related LPN clinical experience in physician offices, acute care, managed care or clinic setting preferred.

Responsibilities

• Review clinical information from physicians and clinical providers to determine if data supports authorization of services.
• Analyze clinical information to ensure authorization aligns with clinical protocols.
• Validate member benefits for requested services and confirm enrollment accuracy in the system.
• Enter accurate information into the claims system to support processing and payment.

Skills

LPN experience

Utilization Management

Diagnostic Imaging experience

Education

High School Diploma (required)

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Milliman

Job description

Sentara Health in Norfolk, VA is seeking an Authorization Coordinator to review clinical information from physicians and other providers to determine if data supports service authorization. You will ensure data aligns with clinical protocols and validate member benefits for the requested services.

The role requires data accuracy in enrollment systems and entering information into the claims system. LPN experience in physician offices or acute care is preferred for this role.