Impactful Utilization Review Specialist

Pioneer Human Services; Spokane (WA); On-site; USD 27,000 - 34,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Retirement Plan

Employee Assistance Program

Job summary

Pioneer Human Services in Spokane, WA is seeking an Utilization Review Administrator to help control costs, improve revenue collection, and ensure data integrity for timely payments. You will review medical records, monitor utilization patterns, authorizations, bed boards, and collaborate with clinical, billing and UM staff to ensure funding and compliance with payer requirements.

Requirements include a high school diploma/GED and at least 1 year in substance use, medical or mental health

Qualifications

• High school diploma or GED is required.
• At least 1 year of experience in substance use, medical, or mental health fields.
• Experience working with individuals with behavioral health conditions is preferred.

Responsibilities

• Monitor utilization patterns and notify leadership of potential utilization issues.
• Review bed boards daily for accuracy.
• Ensure initial authorizations, episodes, and bed boards are completed timely and accurately.
• Monitors, tracks, and analyzes required reports.
• Coordinate with billing, clinical staff, UM team, and finance to ensure data accuracy and timely payments.

Skills

1 year experience in behavioral health

Interpersonal communication

Education

High school diploma/GED

Associates degree preferred

Tools

EMR systems

Job description

Pioneer Human Services in Spokane, WA is seeking an Utilization Review Administrator to help control costs, improve revenue collection, and ensure data integrity for timely payments. You will review medical records, monitor utilization patterns, authorizations, bed boards, and collaborate with clinical, billing and UM staff to ensure funding and compliance with payer requirements.

Requirements include a high school diploma/GED and at least 1 year in substance use, medical or mental health