Impactful Utilization Review Coordinator

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

Benefits offered by this job

Medical

Flexible spending

Dental

Vision

Life, AD&D, Disability

Tuition assistance

Retirement plan

Public transportation discount

EAP

Job summary

Pioneer Human Services in Washington state is seeking a Utilization Review Coordinator to help improve revenue integrity and ensure timely payments. You will critically review guest medical records for completeness, coordinate with clinical teams, and ensure proper authorizations are in place.

The role emphasizes monitoring utilization patterns, appeals processes with payers, and maintaining UR documentation in the EMR. A health-care related degree and relevant experience are valued.

Qualifications

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

Responsibilities

• Reviews treatment plans for documentation, continuity of care, and compliance.
• Reviews client records to determine medical necessity and need for continuing treatment.
• Monitors utilization patterns and notifies leadership of issues.
• Maintains UR documentation in EMR and coordinates with payers.
• Submits appeals for denied authorizations with clinical/demographic data.
• Coordinates with health plans, hospitals, and physicians to ensure coverage.
• Ensures excellent customer service to payers, vendors, and internal customers.
• Maintains access to EMR, payer portals, and required systems.

Skills

Utilization management

Behavioral health experience

Education

Associate's degree in health care / business or related field

Bachelor's degree in health care / business (preferred)

Tools

EMR systems

Payer portals

Quick MAR

Job description

Pioneer Human Services in Washington state is seeking a Utilization Review Coordinator to help improve revenue integrity and ensure timely payments. You will critically review guest medical records for completeness, coordinate with clinical teams, and ensure proper authorizations are in place.

The role emphasizes monitoring utilization patterns, appeals processes with payers, and maintaining UR documentation in the EMR. A health-care related degree and relevant experience are valued.