Utilization Review Administrator; on-site

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.

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.

At Pioneer, we offer a comprehensive benefits package designed to support your health, financial well-being, and continued growth.

• Medical coverage
• Dental coverage
• Vision coverage
• Flexible Spending Account (FSA)
• Dependent Care Flexible Spending Account

• Employer-provided life insurance
• Accidental Death & Dismemberment (AD&D) insurance
• Disability coverage

• Front-Loaded Tuition Assistance
• Retirement Plan
• Employee recognition programs
• Public transportation discounts
• Employee Assistance Program (EAP)

Benefit eligibility, coverage, contributions, and program provisions are subject to the terms of the applicable benefit plans and policies.

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.

• 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…