Prior Authorization LVN Supervisor at LSMA Management Inc

San Bernardino, California, United States -

Full Time

Start Date

Immediate

Expiry Date

16 Jun, 26

Salary

42.0

Posted On

18 Mar, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Supervising, Clinical Criteria Application, Authorization Request Processing, Care Coordination, Compliance, Clinical Guidance, Process Improvement, Liaison, Medical Documentation Interpretation, Communication, Problem-Solving, Decision-Making, Prioritization, Microsoft Office Proficiency, Coding Knowledge

Industry

Health and Human Services

Description

Description JOB SUMMARY 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 MINIMUM & PREFERRED QUALIFICATIONS Education/Training Minimum: Graduate of an accredited Licensed Vocational Nurse Program. Preferred: Training/experience using Milliman Criteria. Experience in medical management, prior authorization, or utilization review. Experience Minimum: 2+ years of related experience and/or training; new graduates may be considered. Preferred: 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. Certification(s) Current State LVN License Skills, Knowledge & Abilities · 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. PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS The physical, mental, and environmental demands described here are representative of those required to successfully perform the essential functions of this job. The Prior Authorization LVN Supervisor role is primarily sedentary, with most of the time spent sitting and performing computer or telephone-based tasks. Occasional standing, walking, bending, and reaching may be required. The position involves light lifting (up to 20 pounds) and frequent hand dexterity for typing and documentation. Stair climbing may be needed periodically.

Responsibilities

The Prior Authorization LVN Supervisor manages the daily workflow of the Prior Authorization team, ensuring clinical criteria are consistently applied and authorization requests are processed promptly. This role involves supervising LVNs and Coordinators, offering clinical direction, and acting as a key liaison between various internal and external stakeholders.