LPN Authorization Specialist: Payor Approvals & Appeals

Steward Health Care; West Monroe (LA); On-site; USD 52,000 - 70,000; Full time

Job summary

Steward Health Care in Louisiana is seeking a qualified Licensed Practical Nurse to support the Utilization Review and Case Management functions. The role focuses on obtaining authorizations, coordinating with payors and clinicians, and ensuring timely information exchange to prevent denials.

The incumbent will document in the care management system, maintain confidentiality, and escalate disputes as needed while adhering to licensure requirements and standard procedures.

Qualifications

• Experience with Microsoft Office, Word, Excel, and Outlook required.
• Experience with EMR strongly preferred.
• Manages time effectively, sets priorities, and consistently meets deadlines.
• Excellent communication skills, both written and oral required.
• Demonstrates initiative and pro-active approach to problem resolution.
• Demonstrates good organizational skills and attention to detail.
• Ability to work independently with little supervision.
• Louisiana licensed LPN required.

Responsibilities

• Validate daily that all Managed care/Commercial cases have an appropriate authorization and notify DCM or UR nurse of variances.
• Document authorization and denial information in Care Management documentation system.
• Submit initial clinical information within 24 hours of admission as directed by UR nurse.
• Concurrently ensure all clinical needs by payors or updates provided by alerting UR nurse and/or DCM.
• Coordinate Peer-to-Peer arrangements between physicians and insurance providers on denials and document outcome.
• Maintain confidentiality of patient/physician/personnel information/hospital proprietary information.
• Perform other duties as assigned.
• Maintain licensure/certification, BLS, etc. as required.

Skills

Communication skills

Time management

Organizational skills

Independent work

Problem-solving

Education

Licensed Practical Nurse (LPN) Louisiana

Tools

EMR

Microsoft Office

Care Management system

Job description

Steward Health Care in Louisiana is seeking a qualified Licensed Practical Nurse to support the Utilization Review and Case Management functions. The role focuses on obtaining authorizations, coordinating with payors and clinicians, and ensuring timely information exchange to prevent denials.

The incumbent will document in the care management system, maintain confidentiality, and escalate disputes as needed while adhering to licensure requirements and standard procedures.