Utilization Management Nurse Specialist
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 Nurse Specialist Location: 100% Remote Duration: 3-Month Contract (Potential for Extension) Schedule: Typically 8:00 AM – 5:00 PM (1-hour lunch). Flexible start times between 7:00 AM and 9:00 AM based on business needs. Position Overview 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 clinical nursing background, experience with utilization management processes, and proficiency with industry-standard care management tools and guidelines.
Required Qualifications
Clinical & Nursing Experience
- Active Registered Nurse (RN) license preferred; Licensed Practical Nurse (LPN) will be considered.
- Current Maryland Nursing License or Compact Nursing License required.
- Minimum of 5 years of clinical nursing experience.
- Minimum of 2 years of Care Management experience.
Utilization Management Experience
- Previous Managed Care and Utilization Review experience required.
- Strong understanding and hands-on experience with MCG (Milliman Care Guidelines).
- Experience performing medical necessity reviews and utilization management functions.
Technical Skills
- Hands-on experience with GuidingCare and Facets is required.
- Proficiency with Microsoft Office Suite and the ability to navigate multiple applications simultaneously.
- Strong documentation, communication, and organizational skills.
Preferred Qualifications
- Critical Care nursing experience.
- Emergency Room (ER) nursing experience.
- Prior experience working within a Blue Plan or similar health insurance environment.
- Previous experience as a Utilization Management Specialist.
- Strong knowledge of healthcare regulations, utilization review processes, and care coordination.
Lumen Solutions Group Inc is an equal opportunity employer. All qualified applicants will be considered for employment without regard to any legally protected status.