City/State

Norfolk, VA

Work Shift

Multiple shifts available

Overview:

Sentara Health Plans is hiring an Authorization Coordinator / Licensed Practical Nurse (LPN)​ for Imaging/ Commercial - Remote in Virginia!

Status: Full-time, permanent position (40 hours)

Standard working hours: 8am to 5pm EST, M-F.

Location: This position is remote in Virginia.

Job responsibilities:

• 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:

• HS - High School Grad or Equivalent REQUIRED

• LPN Diploma or Associate level degree preferred

Certification/Licensure:

• Licensed Practical Nurse (LPN) - Nursing License - Compact/Multi-State License  REQUIRED

Experience:

• 3 years of related clinical experience as an LPN, such as experience in a physician office, acute care, managed care or clinic setting REQUIRED

• Imaging and Health Plan experience is preferred

• Familiar with NCQA standards and turnaround times for prior authorizations.

• Familiarity with MCG and InterQual clinical decision support tools for prior authorizations and utilization review

Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees.

Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals.

We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services—all to help our members improve their health.

Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.

Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!

To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-104711

Talroo - Health Plan

Keywords: Health Plan, Healthcare, Health Insurance, MCO, Managed Care, Remote, Virginia, VA, Authorizations, Licensed Practical Nurse, LPN, Commercial, Imaging

Benefits: Caring For Your Family and Your Career

• Medical, Dental, Vision plans

• Adoption, Fertility and Surrogacy Reimbursement up to $10,000

• Paid Time Off and Sick Leave

• Paid Parental & Family Caregiver Leave

• Emergency Backup Care

• Long-Term, Short-Term Disability, and Critical Illness plans

• Life Insurance

• 401k/403B with Employer Match

• Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education

• Student Debt Pay Down – $10,000

•Pet Insurance 
•Legal Resources Plan
•Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

In support of our mission “to improve health every day,” this is a tobacco-free environment.

For positions that are available as remote work, Sentara Health employs associates in the following states:

Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.