Strategic Utilization & 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

401(k) match

Tuition reimbursement

Paid volunteer time off

Parental leave

Job summary

Duly Health and Care is seeking a detail-oriented Utilization Management Specialist to manage referrals, authorizations, and benefit determinations for capitated and value-based populations. You will collaborate with Medical Directors, care management, providers, and health plans to ensure timely access to care.

The ideal candidate brings strong knowledge of managed care, payer requirements, and CMS guidelines, plus excellent analytical and communication skills to navigate complex cases and

Qualifications

• Associate degree preferred in Healthcare Administration or related field.
• Experience with utilization management and prior authorization.
• Experience with Epic or other EHR preferred.
• Strong analytical, problem-solving, and communication skills.

Responsibilities

• Process referrals, authorizations, and benefit determinations.
• Review eligibility, benefits, medical necessity, and authorization requirements.
• Collaborate with health plans and internal teams to obtain approvals.
• Elevate complex cases to Medical Director for clinical review.
• Maintain documentation and support audits.

Skills

Utilization management

Managed care

Prior authorization

Referral management

Critical thinking

Analytical skills

Communication

Independent work

Organization

Education

Associate degree in healthcare

Equivalent combination of education & experience

Additional coursework in utilization management

Tools

Epic EHR

Microsoft Office

Job description

Duly Health and Care is seeking a detail-oriented Utilization Management Specialist to manage referrals, authorizations, and benefit determinations for capitated and value-based populations. You will collaborate with Medical Directors, care management, providers, and health plans to ensure timely access to care.

The ideal candidate brings strong knowledge of managed care, payer requirements, and CMS guidelines, plus excellent analytical and communication skills to navigate complex cases and