Utilization Review Administrator (on-site)
Pioneer Human Services
1 day ago
Full-time
On-site
Spokane, Washington, United States
$19 - $29 USD hourly
Social Worker
If you are looking for employment with a purpose where you can help improve the daily lives of the members of your community, then consider a career with Pioneer Human Services!
We are currently looking for a Utilization Review Administrator (on-site) with a passion for human services. This is an exciting opportunity to be involved with an organization focused on a transformative path towards social change, creating pathways for rehabilitation, reintegration, and redemption.
Who we are – Our Mission We empower justice-involved individuals to overcome adversity and reach their full potential.
For over 60 years, we have proudly serviced our clients with professionalism and empathy. We are a nationally recognized non-profit with 35+ locations across Washington state that provided a chance for change to over 9,500 individuals in 2024.
What We Offer At Pioneer, our employees are important. That’s why we offer a Total Rewards package that includes compensation and benefits to support employees' health, security, and balance.
Compensation: New hires for this position typically start between $19.86 and $24.82 hourly , depending on factors such as work location, experience, qualifications, skills, competencies, internal equity, and market conditions . While the full pay range is provided to support pay transparency, individual compensation will vary within the range based on these factors. Benefits That Invest in You :
At Pioneer, we offer a comprehensive benefits package designed to support your health, financial well-being, and continued growth.
Health & Wellness Benefits
Medical coverage
Dental coverage
Vision coverage
Flexible Spending Account (FSA)
Dependent Care Flexible Spending Account
Financial Protection
Employer-provided life insurance
Accidental Death & Dismemberment (AD&D) insurance
Disability coverage
Invest in Your Future
Front-Loaded Tuition Assistance
Retirement Plan
Employee recognition programs
Public transportation discounts
Employee Assistance Program (EAP)
Join Pioneer and build more than a career. Be part of a team that supports your well-being, recognizes your contributions, and invests in your future.
Benefit eligibility, coverage, contributions, and program provisions are subject to the terms of the applicable benefit plans and policies .
W hat you ' ll do
As the Utilization Review Administrator you will help control costs, improve revenue collection, and ensure data integrity. The Utilization Review (UR) Administrator critically examines guest medical records for completeness and accuracy to ensure appropriate funding and authorizations are in place for timely and accurate payment. This position works closely with clinical, leadership and administrative staff to ensure Pioneer receives accurate and timely payment for services provided.
Primary/essential duties and responsibilities are but not limited to:
Monitors utilization patterns including daily census, no-shows, and AMAs and notifies leadership of potential utilization issues
Reviews bed boards daily to ensure accuracy
Ensures initial authorizations, episodes, and bed boards are completed in a timely and accurate manner
Monitors, tracks, and analyzes required reports
Maintains applicable UR documentation in Electronic Medical Record (EMR)
Conducts peer-to-peer review with MCO to appeal denials
Submits appeals for denied authorizations with applicable clinical, demographic, and payer information
Coordinates, monitors, and tracks resolution of revenue cycle tickets to help resolve funding and other related, non-clinical, client issues
Ensures clients have access to services while ensuring the client’s right to be in the least restrictive environment as clinically appropriate
Understands and applies MCO, CMS, and insurance requirements for pre-authorization, authorization, concurrent, retrospective, and peer-to-peer review for individuals admitted under voluntary treatment status
Ensures excellent customer service is provided to payers, vendors, and internal customers
Maintains access to Quick Mar, EHR, payer portals and other required systems
Composes and sends professional communication related to medical records and case coordination
Works with UR Coordinator to ensure length of stay for each program is within authorization duration
Monitors and provides appropriate staff updates for authorizations and length-of-stay; assists with transition for continued stays, discharges, or transfers
Collaborates and partners with billing, clinical staff, management, UM team, and finance to ensure data accuracy, operational efficiency, timely financial collection, and adequate task coverage
Maintains working knowledge and collaborative relationships with community partners and resources
Promotes and models teamwork and collaboration with coworkers
Maintains quality of care consistent with or exceeding standards set by federal, state, local, internal, and contract requirements
Adheres to professional and ethical standards for behavioral health services
Develops internal UR policies and procedures
Guides staff in proper completion of clinical documentation to ensure accuracy and quality client care
Maintains current knowledge of federal and state regulations for Medicaid, Medicare, private insurance/managed care, and other related industry programs and practices
Assists with training staff to ensure operational efficiency
What you ' ll bring
High school diploma/GED
1 year of experience working in substance use, medical or mental health fields
1 year of experience working with individuals with behavioral health conditions
Preferably you ' ll bring
Associates Degree in health care, business, or related field
1-year administrative experience in the healthcare or related field (i.e. billing, data entry, invoicing)
Experience working in a residential treatment facility
EEO
Pioneer human services is an equal opportunity employer of minorities/women/individuals with disabilities/protected veterans and does not unlawfully discriminate under federal, state, or local laws. All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, gender, sexual orientation, gender identity, age, physical or mental disabilit y, or protected veteran status. EEOC is the Law/EEO Policy Statement
Pioneer Human Services is a Drug-Free Company
Pioneer Human Services is a drug free company. Pioneer’s existing drug-free workplace policy prohibits the use of marijuana, including medical marijuana, and complies with Washington law. As such, this position is subject to drug testing during employment, to include testing for marijuana
We are currently looking for a Utilization Review Administrator (on-site) with a passion for human services. This is an exciting opportunity to be involved with an organization focused on a transformative path towards social change, creating pathways for rehabilitation, reintegration, and redemption.
Who we are – Our Mission We empower justice-involved individuals to overcome adversity and reach their full potential.
For over 60 years, we have proudly serviced our clients with professionalism and empathy. We are a nationally recognized non-profit with 35+ locations across Washington state that provided a chance for change to over 9,500 individuals in 2024.
What We Offer At Pioneer, our employees are important. That’s why we offer a Total Rewards package that includes compensation and benefits to support employees' health, security, and balance.
Compensation: New hires for this position typically start between $19.86 and $24.82 hourly , depending on factors such as work location, experience, qualifications, skills, competencies, internal equity, and market conditions . While the full pay range is provided to support pay transparency, individual compensation will vary within the range based on these factors. Benefits That Invest in You :
At Pioneer, we offer a comprehensive benefits package designed to support your health, financial well-being, and continued growth.
Health & Wellness Benefits
Medical coverage
Dental coverage
Vision coverage
Flexible Spending Account (FSA)
Dependent Care Flexible Spending Account
Financial Protection
Employer-provided life insurance
Accidental Death & Dismemberment (AD&D) insurance
Disability coverage
Invest in Your Future
Front-Loaded Tuition Assistance
Retirement Plan
Employee recognition programs
Public transportation discounts
Employee Assistance Program (EAP)
Join Pioneer and build more than a career. Be part of a team that supports your well-being, recognizes your contributions, and invests in your future.
Benefit eligibility, coverage, contributions, and program provisions are subject to the terms of the applicable benefit plans and policies .
W hat you ' ll do
As the Utilization Review Administrator you will help control costs, improve revenue collection, and ensure data integrity. The Utilization Review (UR) Administrator critically examines guest medical records for completeness and accuracy to ensure appropriate funding and authorizations are in place for timely and accurate payment. This position works closely with clinical, leadership and administrative staff to ensure Pioneer receives accurate and timely payment for services provided.
Primary/essential duties and responsibilities are but not limited to:
Monitors utilization patterns including daily census, no-shows, and AMAs and notifies leadership of potential utilization issues
Reviews bed boards daily to ensure accuracy
Ensures initial authorizations, episodes, and bed boards are completed in a timely and accurate manner
Monitors, tracks, and analyzes required reports
Maintains applicable UR documentation in Electronic Medical Record (EMR)
Conducts peer-to-peer review with MCO to appeal denials
Submits appeals for denied authorizations with applicable clinical, demographic, and payer information
Coordinates, monitors, and tracks resolution of revenue cycle tickets to help resolve funding and other related, non-clinical, client issues
Ensures clients have access to services while ensuring the client’s right to be in the least restrictive environment as clinically appropriate
Understands and applies MCO, CMS, and insurance requirements for pre-authorization, authorization, concurrent, retrospective, and peer-to-peer review for individuals admitted under voluntary treatment status
Ensures excellent customer service is provided to payers, vendors, and internal customers
Maintains access to Quick Mar, EHR, payer portals and other required systems
Composes and sends professional communication related to medical records and case coordination
Works with UR Coordinator to ensure length of stay for each program is within authorization duration
Monitors and provides appropriate staff updates for authorizations and length-of-stay; assists with transition for continued stays, discharges, or transfers
Collaborates and partners with billing, clinical staff, management, UM team, and finance to ensure data accuracy, operational efficiency, timely financial collection, and adequate task coverage
Maintains working knowledge and collaborative relationships with community partners and resources
Promotes and models teamwork and collaboration with coworkers
Maintains quality of care consistent with or exceeding standards set by federal, state, local, internal, and contract requirements
Adheres to professional and ethical standards for behavioral health services
Develops internal UR policies and procedures
Guides staff in proper completion of clinical documentation to ensure accuracy and quality client care
Maintains current knowledge of federal and state regulations for Medicaid, Medicare, private insurance/managed care, and other related industry programs and practices
Assists with training staff to ensure operational efficiency
What you ' ll bring
High school diploma/GED
1 year of experience working in substance use, medical or mental health fields
1 year of experience working with individuals with behavioral health conditions
Preferably you ' ll bring
Associates Degree in health care, business, or related field
1-year administrative experience in the healthcare or related field (i.e. billing, data entry, invoicing)
Experience working in a residential treatment facility
EEO
Pioneer human services is an equal opportunity employer of minorities/women/individuals with disabilities/protected veterans and does not unlawfully discriminate under federal, state, or local laws. All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, gender, sexual orientation, gender identity, age, physical or mental disabilit y, or protected veteran status. EEOC is the Law/EEO Policy Statement
Pioneer Human Services is a Drug-Free Company
Pioneer Human Services is a drug free company. Pioneer’s existing drug-free workplace policy prohibits the use of marijuana, including medical marijuana, and complies with Washington law. As such, this position is subject to drug testing during employment, to include testing for marijuana