Utilization Management Specialist

Company Description Lumen SolutionsGroupInc. is a technology consulting Services company based inFlorida. Weprovidea wide array of experienced business and IT professionals supporting clients from solution design to implementation and support.We specialize in professional IT consulting services, IT Staffing, Business/IT Strategy, Business Process Blueprints, Enterprise Architecture, and EnterpriseTransformation. Role: Utilization Management Coordinator Location: Remote Job Type: Contract Job S

Job Title: Utilization Management / Prior Authorization (GuidingCare) Location: Reston, VA ( Remote Job ) Duration: 3 Months+ Purpose: Supports the Utilization Management clinical teams by assisting with non-clinical administrative tasks and responsibilities related to pre-service, utilization review, care coordination and quality of care. Essential Functions: 35% Performs member or provider related administrative support which may include benefit verification, authorization creation and

Company Description Lumen SolutionsGroupInc. is a technology consulting Services company based inFlorida. Weprovidea wide array of experienced business and IT professionals supporting clients from solution design to implementation and support.We specialize in professional IT consulting services, IT Staffing, Business/IT Strategy, Business Process Blueprints, Enterprise Architecture, EnterpriseTransformation. Role:Utilization Review Nurse Location: Baltimore MD(Remote) Type:Contract Job Descrip

Required skills: Epic Tapestry Utilization Management Certification (active). 35+ years hands-on Epic Tapestry UM build/support experience specifically in UM authorizations and referrals. Demonstrated experience implementing and supporting Tapestry Care Link for external provider/referral workflows. Proven ability to configure UM routing rules, workqueues, decisioning tools, letters/notifiations, and SLAs. Solid understanding of payer operations and UM regulations (e.g., CMS timelines, state TA