Utilization Management Coordinator

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, Enterprise Transformation.

Role: Utilization Management Coordinator Location: Canton, MD (100% Remote) Type: 3 Months Contract

About the Role: The Utilization Management Coordinator will support Government Programs by managing authorization workflows and provider communications in a high-volume call center environment. This role requires strong utilization management experience and the ability to work efficiently in fast-paced, queue-driven settings.

Key Responsibilities:

• Process incoming faxed authorization requests.
• Create, update, and manage utilization management authorizations.
• Handle provider line phone calls in a call center environment.
• Navigate multiple systems to document and resolve requests accurately.
• Maintain compliance with Medicaid and Medicare program requirements.
• Manage high call volumes (approximately 80–120 calls per day across the team).

Qualifications:

• 3+ years of Utilization Management experience (required).
• Call center experience in a high-volume environment (mandatory).
• Familiarity with CPT, ICD, and HCPCS codes (minimum recognition level).
• Experience supporting Medicaid and/or Medicare programs.
• Strong attention to detail and ability to multitask across systems.

Preferred Qualifications:

• GuidingCare experience (strongly preferred; primary system).
• Facets experience.
• NICE CXone experience.
• Healthcare payer or managed care organization background.

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