Impactful Utilization Review Coordinator

Pioneer Human Services; Everett (WA); On-site; USD 38,000 - 47,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Flexible Spending Account (FSA)

Dependent Care FSA

Life insurance

AD&D insurance

Disability coverage

Front-Loaded Tuition Assistance

Retirement Plan

Employee recognition programs

Public transportation discounts

Employee Assistance Program (EAP)

Job summary

Pioneer Human Services is seeking an Utilization Review Coordinator to help ensure proper funding, authorizations, and timely payments for services. The role collaborates with clinical, leadership, and administrative staff to maintain data integrity and support high-quality care for clients in our community.

The position requires an associate degree or equivalent experience in utilization management or medical administration, with 2 years in behavioral health or substance use fields.

Qualifications

• Associate's degree in health care, business, or related field (or two years of UM/Medical Administrative Assistant experience).
• 2 years of experience working with individuals with behavioral health conditions.
• 2 years of experience working in substance use or mental health fields.

Responsibilities

• Reviews treatment plans to ensure proper documentation and continuity of care.
• Reviews client records using utilization criteria to determine medical necessity.
• Monitors utilization patterns and notifies leadership of issues.
• Maintains UR documentation in Electronic Medical Record (EMR).
• Coordinates with health plan organizations, hospitals, doctors, and pharmacists to ensure services are covered.
• Collaborates with billing, clinical staff, UM team, and finance to ensure data accuracy and timely financial collection.

Skills

Utilization Management

Team collaboration

Education

Associate's degree

Bachelor's degree or higher (preferred)

Job description

Pioneer Human Services is seeking an Utilization Review Coordinator to help ensure proper funding, authorizations, and timely payments for services. The role collaborates with clinical, leadership, and administrative staff to maintain data integrity and support high-quality care for clients in our community.

The position requires an associate degree or equivalent experience in utilization management or medical administration, with 2 years in behavioral health or substance use fields.