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.
Position Overview
We are seeking a highly skilled and experienced Utilization Management Specialist – Behavioral Health to join our team. The ideal candidate will be a Board Certified Behavior Analyst (BCBA) with experience providing Applied Behavior Analysis (ABA) services to children with autism and developing individualized treatment plans. This role will support utilization management activities, including clinical reviews, authorization reviews, and medical necessity determinations for behavioral health services.
Experience treating children diagnosed with Autism Spectrum Disorder (ASD).
Demonstrated experience developing and implementing individualized treatment plans.
Preferred Qualifications
Prior experience in:
Utilization Management (UM)
Clinical Reviews
Authorization Reviews
Medical Necessity Reviews
Experience using clinical criteria and decision-support tools such as:
MCG Guidelines
InterQual
Experience working with:
Electronic Medical Record (EMR) systems
Electronic clinical documentation platforms
Healthcare authorization and utilization management systems
Key Responsibilities
Conduct utilization management reviews for behavioral health and ABA services.
Evaluate treatment plans and supporting clinical documentation to determine medical necessity.
Perform authorization and concurrent reviews in accordance with organizational policies and clinical guidelines.
Assess member needs and ensure appropriate utilization of behavioral health services.
Collaborate with providers and care teams regarding treatment recommendations and service authorizations.
Maintain accurate and timely documentation within electronic medical record (EMR) systems and authorization platforms.
Apply clinical judgment and evidence-based practices to support quality care outcomes.
Ensure compliance with regulatory, accreditation, and payer requirements.
Lumen Solutions Group Inc is an equal opportunity employer. All qualified applicants will be considered for employment without regard to any legally protected status.
Numbers & Facts
Location
Baltimore, MD (Remote)
Skills
Accredited Business Accountants (ABA)unmatched
Analysis Skillsunmatched
Autismunmatched
Behavioral Healthunmatched
Blueprintsunmatched
Business Processesunmatched
Business Strategyunmatched
Child and Youth Servicesunmatched
Clinical Practices/Protocolsunmatched
Clinical Study Publicationsunmatched
Clinical Validationunmatched
Consultingunmatched
Decision Supportunmatched
Documentationunmatched
Electronic Medical Recordsunmatched
Enterprise Architectureunmatched
Healthcareunmatched
Information Technology Consultingunmatched
Needs Assessmentunmatched
Patient Care Authorizationsunmatched
Professional Servicesunmatched
Support Documentationunmatched
Technical Recruitingunmatched
Technical Supportunmatched
Time Managementunmatched
Treatment Evaluationunmatched
Treatment Planunmatched
Utilization Managementunmatched
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