Duly Health and Care · 22 hours ago
Utilization Management Supervisor
Downers Grove, IL
Full-time
Onsite
Mid Level
$63K/yr - $94K/yr
3+ years expDuly Health and Care is seeking a Utilization Management Supervisor in Downers Grove. This role is responsible for educating staff on Utilization Management policies and overseeing referral processing to ensure compliance with health plan requirements.
Health CarePersonal HealthWellness
Responsibilities
The Supervisor, Utilization Management (Outpatient Services)/(AUM) is responsible for educating all AUM as to the Utilization Management (AUM) department policies, process and Health plan requirements relating to referrals and pre-certifications
This position is also responsible for overseeing staff assignments to facilitate referral processing in accordance with established policy
Serves as staff resource for Clinical Operations and Compliance within the Clinical Services division of Boncura/Duly Health and Care
Motivates team and Leads team through change in a rapidly growing and evolving department and industry
Maintains tools and reporting for tracking ongoing status of department operations and employee performance metrics related to daily productivity, and documentation compliance
Ability to assess problems and prioritize work in a high volume, fast paced setting is required. Critical thinking skills required. Ability to effectively speak with Physicians and Medical Directors is required
Develops and maintains reference materials that support the AUM Department Policy and Procedure and are consistent with Health Plan, CMS, NCQA, or DOI guidelines as appropriate
Assist the AUM staff in the daily generation and processing of referrals, denials, appeals, and activities
Provides education to all newly hired AUM staff and provides ongoing training to all AUM Staff to ensure that all AUM Policy is appropriately understood and consistently applied
Prioritize daily work and adjust staff assignments to promote compliance with documentation, turnaround times, and compliance with all required AUM activities
Monitor phone queue statistics and provide consistent feedback to staff on performance metrics. Ensure that all incoming telephone calls to the queues are answered promptly, the caller’s issues are addressed, and any identified problems are brought to resolution when necessary
Act as a resource and subject matter expert for staff, Physicians, and office Staff in regard to referral processes, health plan benefits, and processing of day-to-day AUM activities
Document all pertinent information obtained through discussion with providers, patients, family members and other health care professionals in appropriate EMR
Work collaboratively with leadership to develop/address corrective action plans as needed
Maintain confidentiality, related to patients and employees, as stipulated in the confidentiality policy
Perform other projects and duties as related to department objectives
Qualification
Required
High school Degree Required
Prior Operations Experience Required
Proficient in use of Microsoft Office (Outlook, Word, Excel, PowerPoint)
Ability to assess problems and prioritize work in a high volume, fast paced setting is required
Critical thinking skills required
Ability to effectively speak with Physicians and Medical Directors is required
Preferred
3+ years Managed Care Experience preferred
Leadership experience preferred
EPIC experience preferred, but not required
Benefits
Comprehensive medical, dental, and vision benefits that include healthcare navigation assistance.
Access to a mental health benefit at no cost.
Employer provided life and disability insurance.
$5,250 Tuition Reimbursement per year.
Immediate 401(k) match.
40 hours paid volunteer time off.
A culture committed to community engagement and social impact.
Up to 12 weeks parental leave at 100% pay and a financial benefit for adoption and surrogacy for non-physician team members once eligibility require
Company
Duly Health and Care
Duly Health and Care is a Midwest-based independent, multi-specialty physician-directed medical group.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Daniel Greenleaf
Chief Executive Officer
Abigail Kleber
Talent Access Partner
Recent News
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2025-12-02
2025-10-22
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