Utilization Management Nurse Specialist
Lumen Solutions Group, Inc.Baltimore, MD
Automate your job search with Sonara.
Submit 10x as many applications with less effort than one manual application.1
Reclaim your time by letting our AI handle the grunt work of job searching.
We continuously scan millions of openings to find your top matches.
Overview
Remote
On-site
Job Description
Company DescriptionLumen Solutions Group Inc. is a technology consulting Services company based in Florida. We provide a 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 Enterprise Transformation. Role: Utilization Management Nurse SpecialistLocation: 100% Remote Duration: 3-Month Contract (Potential for Extension)Job Description: We are seeking an experienced Utilization Management Nurse Specialist to support utilization review and care management activities within a managed care environment. The ideal candidate will have a strong clinicalnursing background, experience with utilization management processes, and proficiency with industry-standard care management tools and guidelines.Position Overview
- Review medical records and evaluate the medical necessity of healthcare services.
- Apply MCG (Milliman Care Guidelines) to make utilization management decisions.
- Perform utilization review and care management activities in accordance with payer policies.
- Collaborate with physicians, hospitals, and healthcare providers to coordinate patient care.
- Document reviews and maintain accurate case information using GuidingCare and Facets.
- Manage multiple applications while ensuring timely and accurate case processing.
- Active RN (preferred) or LPN license with a Maryland or Compact Nursing License.
- Minimum 5 years of clinical nursing experience.
- Minimum 2 years of Care Management experience.
- Previous Utilization Management or Utilization Review experience in a managed care or health insurance environment.
- Hands-on experience with:
- MCG (Milliman Care Guidelines)
- GuidingCare
- Facets
- Proficient with Microsoft Office and working across multiple systems.
- Critical Care or Emergency Room (ER) nursing experience.
- Experience supporting Blue Cross Blue Shield or other health insurance plans.
- Previous experience as a Utilization Management Specialist.
Automate your job search with Sonara.
Submit 10x as many applications with less effort than one manual application.
FAQs About Utilization Management Nurse Specialist Jobs at Lumen Solutions Group, Inc.
What is the work location for this position at Lumen Solutions Group, Inc.?
This job at Lumen Solutions Group, Inc. is located in Baltimore, MD, according to the details provided by the employer. Some roles may also include multiple work locations depending on the requirement.
What pay range can candidates expect for this role at Lumen Solutions Group, Inc.?
Employer has not shared pay details for this role.
What employment applies to this position at Lumen Solutions Group, Inc.?
The employer has not provided this information. This may be discussed during the hiring process.
What is the process to apply for this position at Lumen Solutions Group, Inc.?
You can apply for this role at Lumen Solutions Group, Inc. either through Sonara's automated application system, which helps you submit applications 10X faster with minimal effort, or by applying manually using the direct link on the job page.