Utilization Management Specialist 4-2026

As a Utilization Management Specialist , you'll support the UM team by managing service authorizations, meeting strict regulatory standards, and keeping processes running smoothly—even during high-demand periods.

What You'll Do:

Process and file medical authorizations with precision. Communicate outcomes to providers and maintain accurate member records. Triage calls, handle mail, and manage documentation in the care management system. Assist with data entry, reporting, and creating graphs for annual UM reports. Coordinate urgent requests, pharmacy authorizations, and special projects. Ensure compliance with

DHS, CMS & NCQA

standards while meeting turnaround times.

Key Qualifications Education :

High school diploma or equivalent required; post-secondary coursework in healthcare or business preferred.

Experience :

1-2 years in healthcare administration, utilization management, or related field.

Skills :

Strong attention to detail and organizational skills. Ability to manage multiple priorities and meet deadlines. Proficiency with Microsoft Office and data entry systems. Excellent communication and customer service skills.

Knowledge of :

Healthcare terminology, regulatory requirements (DHS, CMS), and NCQA is a plus. Why You'll Love Working Here Medical Insurance Vision Materials Coverage Long-Term Disability (LTD) Coverage Life Insurance Pension Plan (PERA) 13 Paid Holidays Vacation Bank Sick Leave Bank Volunteer Time Off (VTO) Fitness Center Onsite Make a real impact on healthcare quality while working in a collaborative, supportive environment. Ready to join a team where accuracy and compassion matter? Apply today!