Utilization Review Coordinator I

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 Coordinator I with a passion for human services. This is an exciting opportunity to be involved with an organization focused on lowering the barriers to a successful reentry for returning citizens, racial justice, and diversity, equity and inclusion.

Who we are
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 50+ locations across Washington state that provides a chance for change to over 3,000 people on any given day.

What you'll do
The goal of utilization management is to control costs, improve revenue collection, and ensure data integrity. The UR Coordinator I 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 durties are but not limited to:

• 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
• 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

• Negotiates length of stay with payers
• Collaborates with clinical team to ensure accuracy of payer information, placement, clinical status, and discharge needs
• Coordinates with health plan organizations, hospitals, doctors, and pharmacists to ensure services are covered and to improve treatment outcomes
• Composes and sends professional communication related to medical records and case coordination
• 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

What you'll bring

• Associate’s degree in health care, business, or related field
• 1 year of experience as a Substance Use Disorder Professional or Trainee
• 1 year of experience working with individuals with behavioral health conditions

Preferably you'll bring

• Bachelor’s degree or higher in health care, business or related field
• Dually Credentialed as SUDP/T and MHP
• 1 year of administrative experience in the healthcare or related field (i.e. billing, data entry, invoicing)

Experience working in a residential treatment facility

What we offer

Our employees are important. That’s why at Pioneer Human Services we’re committed to competitive industry compensation and a comprehensive employee benefits program that helps our employees stay healthy, feel secure and maintain balance. Employees working a minimum of 30 hours per week on a regular basis are eligible to participate the first of the month following 30 days of full-time employment in:

• Medical
• Flexible-spending
• Dental

• Vision coverage

After 60 days of full-time employment coverage for

• Life,
• AD&D, and disability

Other benefits include:

• Dependent Daycare flexible spending. 
• Tuition assistance program: Pioneer pays 100% of a bachelor's degree tuition and 50% for graduate programs. Available for full-time status employees after 3 months of employment.
• Retirement plan: Pioneer contributes 3.5% of an employee's annual compensation into retirement plans. An additional 3.5% match is offered to those who contribute 6% on their own.
• Employee recognition programs: gift cards, additional time off, weekend getaways and more.
• Public transportation discount.
• Employee assistance program (EAP).

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 disability, or protected veteran status. EEO is the law poster EEO is the law poster supplement 

Pioneer Human Services is a Drug-Free Company

Pioneer Human Services is a drug free company. This position has been deemed safety sensitive under RCW 49.44.240(3) and is subject to both pre-employment drug testing and drug testing during employment, to include testing for marijuana.