What are the responsibilities and job description for the Prior Authorization LVN Supervisor position at LSMA Management, Inc.?
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
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.
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.
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.