Utilization Management Coordinator

Must have off-entry and processing experience. This role will involve handling and processing Utilization and authorization request via FAX and some calls. Experience with guiding care and Facets ROLE: 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. (this position is remote) ESSENTIAL FUNCTIONS: Performs member or provider related administ

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 Management Nurse Specialist Location: 100% Remote Duration: 3-Month Co

Utilization Review Specialist (RN, LPN)Introduction:We are looking for a Maryland or Compact State certified Utilization Review Specialist (RN or LPN) to join our team and support a major Healthcare payor in the Maryland area. The ideal candidate will have extensive experience in nursing, utilization management, and a deep understanding of Milliman Care Guidelines (MCG). Responsibilities:Determine medical necessity and appropriateness by referencing regulatory mandates, contracts, benefit inform

Hi, Hope youre doing well!! Please find the requirement below. If you find yourself comfortable with the requirement please reply back with your updated resume or call me back at Position:Utilization Management Specialist - Behavioral Health Location:Remote(Must reside in the DMV area Maryland, Virginia, or Washington, DC) Duration: 6+ Months Visa: Client won't be able to sponsor any visa LinkedIN ID We are seeking experiencedBoard Certified Behavior Analysts (BCBAs)to join our cl