Prior Authorization LVN Supervisor
About The Position
The Prior Authorization LVN Supervisor oversees the daily operations of the Prior Authorization team, ensuring consistent application of clinical criteria, timely processing of authorization requests, and coordination of care. This role ensures compliance with CMS, Milliman, Healthcare Management Guidelines, and Medical Management policies. Responsibilities include supervising LVNs and Prior Auth Coordinators, reviewing authorization requests, providing clinical guidance, supporting process improvements, and serving as a liaison with providers, the UM Manager, Medical Director Reviewer (MDR), and health plans.
Requirements
- Graduate of an accredited Licensed Vocational Nurse Program.
- 2+ years of related experience and/or training; new graduates may be considered.
- Current State LVN License
- Ability to read/interpret medical documentation and clinical criteria.
- Strong verbal and written communication skills; ability to present information to staff and small groups.
- Service-oriented, professional, collaborative attitude.
- Competency with Microsoft Office (Word, Excel, Outlook, Access, PowerPoint) and standard office equipment.
- Knowledge of ICD-10, CPT, and HCPCS coding.
- Ability to prioritize multiple high-priority tasks efficiently.
- Strong reasoning, problem-solving, and decision-making abilities.
Nice To Haves
- Training/experience using Milliman Criteria.
- Experience in medical management, prior authorization, or utilization review.
- Experience in multi-specialty clinical environments.
- Experience supervising clinical or administrative teams.
- Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration of this position.
Responsibilities
- Oversee daily operations of the Prior Authorization team
- Ensure consistent application of clinical criteria
- Ensure timely processing of authorization requests
- Coordinate care
- Ensure compliance with CMS, Milliman, Healthcare Management Guidelines, and Medical Management policies
- Supervise LVNs and Prior Auth Coordinators
- Review authorization requests
- Provide clinical guidance
- Support process improvements
- Serve as a liaison with providers, the UM Manager, Medical Director Reviewer (MDR), and health plans
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
