Utilization Review Coordinator - Impactful Health & Revenue

Pioneer Human Services; Sedro-Woolley (WA); Vor Ort; USD 38.000 - 47.000; Vollzeit

Benefits dieser Stelle

Health coverage

Dental coverage

Vision coverage

Flexible Spending Account

Dependent Care FSA

Life insurance

AD&D insurance

Disability coverage

Tuition assistance

Retirement plan

Employee recognition

Public transportation discounts

Employee Assistance Program

Zusammenfassung

Pioneer Human Services is seeking a focused Utilization Review Coordinator to help manage client records, ensure medical necessity, and secure timely authorizations for services across Washington state.

This role collaborates with clinical and administrative teams to monitor utilization and maintain accurate EMR documentation, supporting positive patient outcomes and compliant funding workflows.

Qualifikationen

• Associate’s degree in health care, business, or related field or two years of experience in Utilization Management/Medical Administrative Assistant
• 2 years of experience working with individuals with behavioral health conditions
• 2 years of experience working in substance use or mental health fields
• Bachelor’s degree or higher in health care, business, or related field (preferred)

Aufgaben

• Reviews treatment plans to ensure proper documentation and continuity of care
• Reviews client records using utilization criteria to determine medical necessity and need for continuing treatment
• Monitors utilization patterns, daily census, no-shows, and AMAs
• Maintains UR documentation in EMR
• Composes and sends professional communications related to medical records and case coordination
• Collaborates with billing, clinical staff, management, UM team, and finance to ensure data accuracy and timely financial collection
• Promotes teamwork and collaboration with coworkers
• Maintains knowledge of Medicaid, Medicare, and private insurance requirements for pre-authorization, authorization, and peer-to-peer review

Kenntnisse

Utilization Management

Medical Administrative Assistant

Ausbildung

Associate’s degree in health care, business, or related field

Bachelor’s degree or higher (preferable)

Jobbeschreibung

Pioneer Human Services is seeking a focused Utilization Review Coordinator to help manage client records, ensure medical necessity, and secure timely authorizations for services across Washington state.

This role collaborates with clinical and administrative teams to monitor utilization and maintain accurate EMR documentation, supporting positive patient outcomes and compliant funding workflows.