Payment Integrity – Clinical LPN

2026-4580 Who We Are Because health is personal. That's why Personify Health created the first and only personalized health platform—bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. We serve employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes. Together, our team is on a mission to empower people to lead healthier lives. Learn even more about the work that drives us at personifyhealth.com.

Responsibilities

Ready to The Payment Integrity - Clinical LPN supports the clinical and administrative coordination of Single Case Agreements for out-of-network services. This role partners closely with Care Management, Payment Integrity, Cost Containment, and Provider Relations to ensure SCA requests are complete, clinically supported, timely, and compliant with internal policies and client plan requirements. The LPN serves as a key point of contact for gathering documentation, tracking SCA status, and facilitating communication between internal teams and external providers. What You'll Actually Do

• Receive, review, and track Single Case Agreement (SCA) requests for completeness and accuracy, ensuring required clinical and demographic information is obtained prior to submission.
• Support Care Managers and Payment Integrity teams by gathering clinical documentation that substantiates medical necessity for out-of-network services.
• Enter, update, and maintain SCA requests in designated systems (e.g., Smartsheet, case management platforms), ensuring accurate status tracking and documentation.

Clinical & Administrative Support

• Review member eligibility, benefits, and plan provisions related to out-of-network services and Single Case Agreements.
• Assist in identifying appropriate scenarios for SCA consideration, including continuity of care, lack of in-network availability, or specialized services.
• Collaborate with internal clinical staff (RNs, Care Managers, Medical Directors) to escalate cases requiring clinical review or urgent handling.

Provider & Internal Communication

• Serve as a liaison between providers, internal clinical teams, and Payment Integrity regarding SCA documentation requirements and next steps.
• Communicate professionally with provider offices to obtain missing information, clarify services requested, and support timely SCA processing.
• Document all communications and actions in accordance with internal SOPs and compliance standards.

Compliance & Quality

• Adhere to established Single Case Agreement policies, workflows, and turnaround time expectations.
• Ensure all SCA activity aligns with regulatory, contractual, and client-specific requirements.
• Participate in quality audits, process improvement initiatives, and training related to SCA workflows.

Qualifications

What You Bring to Our Team

Required Qualifications

• Active, unrestricted Licensed Practical Nurse (LPN) license in the applicable state(s).
• 2+ years of clinical or healthcare administrative experience (e.g., care management, utilization management, prior authorization, or medical management support).
• Working knowledge of healthcare benefits, out-of-network services, and medical terminology.
• Strong organizational skills with the ability to manage multiple cases simultaneously in a fast-paced environment.

________________________________________

Preferred Qualifications

• Experience supporting Single Case Agreements, Letters of Agreement (LOAs), or out-of-network negotiations.
• Experience working with care management or payment integrity teams.
• Familiarity with case management systems, Smartsheet, or similar tracking tools.
• Remote work experience in a health plan, TPA, or managed care organization.

________________________________________ Key Competencies

• Attention to detail and documentation accuracy
• Professional communication and provider engagement
• Time management and prioritization
• Collaboration across clinical and non-clinical teams
• Understanding of medical necessity and benefit interpretation

________________________________________ Working Conditions

• Primarily remote, sedentary work
• Frequent computer and phone use
• Standard business hours with occasional time-sensitive requests

Benefits

The Highlights:

• Competitive base salary and benefits effective day one
• Comprehensive medical and dental through our own health solutions (yes, we use what we build)
• Paid Time Off—rest and recharge time is non-negotiable
• Mental health support, retirement planning, and financial protection
• Professional development with clear career progression and learning budgets
• Mission-driven culture where diverse perspectives drive real impact on people's health

Want the full picture? Visit personifyhealthbenefits.com to explore our complete benefits package, wellness programs, and other employee perks. Compensation: This position offers a base salary range of $26.15-$32.70 per hour, depending on location, skills, and experience. You're eligible for our full benefits package starting day one. Our Commitment: Personify Health is an equal opportunity employer committed to diversity, equity, inclusion, and belonging. We cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive—because diversity is core to who we are and critical to our work in health and wellbeing. Stay Safe: Personify Health will never ask for payment or sensitive personal information like social security numbers during hiring. All official communication comes from verified company email addresses and or our secure applicant tracking system. Suspicious requests? Report them to [email protected]. View all legitimate openings at personifyhealth.com/careers.