Utilization Management Coordinator

Job Title: Utilization Management - RN/LPN (Care Management) Location: Baltimore, MD Duration: 12 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 management, claims i

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

Job Description: Must: Registered Nurse License, active and unencumbered state license in the state where job duties are performed isBSN preferred. 2. Four (4) years of clinical practice nursing experience in at least one of the following areas: medical-surgical nursing, surgical nursing, intensive care or critical care nursing.Duties: Utilization Management: Conducts and monitors clinical review cases to ensure medical necessity of inpatient and outpatient services, diagnostic procedures, out-o

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