Virginia Licensed Practical Nurse

Job Summary

As a full-time remote Authorization Coordinator / Licensed Practical Nurse (LPN) for Imaging/Commercial in Virginia, the candidate will manage the review of clinical information from providers to ensure adequate authorization for services, validate member benefits, and ensure compliance with clinical protocols and regulatory requirements.

Key responsibilities:

• Review clinical information to authorize services based on clinical protocols
• Validate member benefits and insurance enrollment information prior to service authorization
• Ensure accurate data entry into the claims system for payment processing

Required qualifications:

• Current Virginia Licensed Practical Nurse (LPN) license - Compact/Multi-State License required
• High School Graduate or equivalent required; LPN Diploma or Associate degree preferred
• A minimum of 3 years of related clinical experience as an LPN
• Knowledge of managed care contracting and clinical review requirements
• Familiarity with NCQA standards and clinical decision support tools for prior authorizations