Utilization Review & Revenue Optimization Specialist

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

Dependent Daycare Flexible Spending

Tuition assistance

Retirement plan

Employee recognition programs

Public transportation discount

Employee assistance program

Job summary

Pioneer Human Services is seeking an Utilization Review Coordinator to support UR management, document medical necessity, and coordinate payer interactions. This role focuses on ensuring accurate funding and timely authorizations across clinical and administrative teams.

The position emphasizes collaboration with nursing, billing, and management to maintain data integrity and promote efficient revenue cycles in a community-based nonprofit setting.

Qualifications

• 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

Responsibilities

• Reviews treatment plans to ensure proper documentation, continuity of care, and compliance
• Reviews client records using utilization criteria to ensure medical necessity and determine need for continuing treatment
• Monitors utilization patterns including daily census, no-shows, and AMAs and notifies leadership of potential utilization issues
• Maintains applicable UR documentation in EMR
• Coordinates, monitors, and tracks resolution of revenue cycle tickets to help resolve funding and other related, non-clinical, client issues
• Collaborates with clinical team to ensure accuracy of payer information, placement, clinical status, and discharge needs

Skills

Utilization Management

Medical Administrative Assistant

Healthcare

Behavioral Health

Education

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

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

Tools

EMR (Electronic Medical Record)

Payer portals

Quick Mar

Job description

Pioneer Human Services is seeking an Utilization Review Coordinator to support UR management, document medical necessity, and coordinate payer interactions. This role focuses on ensuring accurate funding and timely authorizations across clinical and administrative teams.

The position emphasizes collaboration with nursing, billing, and management to maintain data integrity and promote efficient revenue cycles in a community-based nonprofit setting.