Utilization Management Coordinator

Company Description
Lumen 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 Coordinator
Location: Baltimore, MD (Remote)
Job Type: 3 Months Contract (Possible Extension)

Job Summary:
We are seeking a Utilization Management Coordinator with 3+ years of Utilization Management (UM) experience to support prior authorization activities for Medicaid, Medicare, and Commercial health plans. This role involves processing incoming faxes, creating and managing authorizations, reviewing UM cases, and handling provider inquiries in a high-volume call center environment.

Key Responsibilities

• Process incoming faxes and manage prior authorization requests.
• Create, update, and maintain utilization management authorizations.
• Review UM cases and ensure accurate documentation.
• Handle provider phone calls in a fast-paced call center environment.
• Collaborate with internal teams to support authorization and care management workflows.

Required Skills & Qualifications

• 3+ years of Utilization Management experience in a healthcare payer or managed care environment.
• Call center experience is required.
• Working knowledge of CPT, ICD, and HCPCS coding.
• GuidingCare experience is strongly preferred (top priority).
• Experience with Facets and NiceXone is a plus.

Lumen Solutions Group Inc is an equal opportunity employer. All qualified applicants will be considered for employment without regard to any legally protected status.