Authorization & Care Access Specialist

Duly Health and Care; Downers Grove (IL); On-site; USD 40,000 - 60,000; Full time

Benefits offered by this job

Medical, dental, and vision benefits

Mental health benefit at no cost

Employer provided life and disability

Tuition reimbursement

Immediate 401(k) match

Volunteer time off

Parental leave and adoption/surrogacy

Job summary

Duly Health and Care is seeking a qualified Utilization Management professional to review referrals and authorizations, ensuring medical necessity and payer compliance. You will work with Medical Directors, care teams, and health plans to resolve barriers and expedite access to services.

The role requires experience in utilization management, prior authorization, and strong communication skills within a high-volume care setting. A valid EHR background and collaborative mindset are essential.

Qualifications

• Minimum of 2 years of utilization management, prior authorization, referral management, or related managed care experience.
• Experience applying MCG Guidelines or comparable evidence-based medical necessity criteria.
• Experience working with health plans and payer representatives.

Responsibilities

• Process referrals, authorizations, and benefit determinations in accordance with policies and regulatory standards.
• Review referral requests for eligibility, benefits, medical necessity, network participation, and authorization requirements.
• Contact health plans and payer representatives to obtain required authorizations and clarify benefits.
• Collaborate with Medical Directors, care teams, and providers to resolve authorization barriers and ensure access to services.
• Maintain accurate documentation in EHR and utilization management systems, and support audits and quality reporting.

Skills

Utilization management

Prior authorization

Referral management

Communication skills

Problem solving

Attention to detail

Education

Associate degree in Healthcare Administration/related

Tools

Epic

Job description

Duly Health and Care is seeking a qualified Utilization Management professional to review referrals and authorizations, ensuring medical necessity and payer compliance. You will work with Medical Directors, care teams, and health plans to resolve barriers and expedite access to services.

The role requires experience in utilization management, prior authorization, and strong communication skills within a high-volume care setting. A valid EHR background and collaborative mindset are essential.