Open to opportunities

Erin Lowmaster

@erinlowmaster

Message

I lead utilization management reviews that strengthen clinical compliance, documentation quality, and team performance.

United States

Message

What I'm looking for

I'm looking for a utilization management or clinical leadership role where I can improve review quality, support compliance, mentor clinicians, and strengthen care coordination.

I'm currently conducting medical necessity reviews at Humana for Medicaid long-term care members, including home care, durable medical equipment, and CMS-related services.

I collaborate with medical directors on ICT and fair hearing reviews and mentor new employees to build team competency.

At CareCentrix, I led clinical review teams supporting post-acute care, home health, and Medicare clients. I coached clinicians, monitored productivity and turnaround times, audited denial letters, and used root-cause analysis to improve processes.

Earlier at UnitedHealthcare/Optum, I managed prior authorization and concurrent utilization review for inpatient care across Medicare, Medicaid, and commercial health plans.

Experience

Work history, roles, and key accomplishments

Current

Utilization Management Nurse

Current

Humana

Jun 2025 - Present (1 year 3 months)

Conducts comprehensive medical necessity reviews for Medicaid long-term care population ensuring compliance with CMS standards. Performs utilization management reviews for home care, durable medical equipment, and CMS-related services, and collaborates with medical director in ICT and fair hearing reviews.

Utilization Management Medical Necessity Review CMS Compliance Medicaid Long Term Care Home Care Durable Medical Equipment Collaboration Mentorship

Utilization Management Team Lead

CareCentrix

Apr 2021 - May 2025 (4 years 1 month)

Led clinical review team for post-acute care (SNF/IRF/LTAC) and home health Medicare clients. Delivered education and coaching on utilization review process, monitored clinician productivity, and conducted audits and quality assurance of denial letters.

Utilization Management Team Leadership Post Acute Care Medicare Coaching Mentorship Productivity Monitoring Audit Quality Assurance Root Cause Analysis Process Improvement Project Management

Utilization Management Nurse

United Healthcare/Optum

Jun 2015 - Apr 2021 (5 years 10 months)

Managed utilization review including prior authorization and concurrent review for inpatient care management. Conducted pre-certification, inpatient, retrospective, and out-of-network reviews applying medical policies and clinical guidelines.