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 Management Supervisor 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 our most valuable asset. That’s why we’re proud to offer a comprehensive Total Rewards package designed to support your health, security, and work-life balance.

Compensation:

New hires for this position typically start between $27.01 and $33.77 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:

Eligible after 30 days of full-time employment (minimum of 30 hours/week):

• Medical
• Flexible spending
• Dental
• Vision

Additional coverage after 60 days:

• Life
• AD&D
• Disability

Other benefits:

• Dependent Daycare Flexible Spending
• Tuition assistance (100% for bachelor's, 50% for graduate programs)
• Retirement plan (3.5% annual compensation contribution, plus 3.5% match for 6% individual contribution)
• Employee recognition programs
• Public transportation discount
• Employee assistance program (EAP)

Join Pioneer and be part of a team that values and invests in you.

What you'll do

As a Utilization Management leader, you will play a critical role in ensuring high-quality, compliant, and efficient utilization management (UM) and utilization review (UR) services across your assigned region. You will provide operational oversight, support staff development, ensure fiscal and regulatory compliance, and collaborate across departments to support quality, cost-effective behavioral health services.

Primary/essential duties and responsibilities are but not limited to:

• Oversee daily UM operations within your region, ensuring accuracy, quality, and compliance across all UM/UR processes.
• Supervise UM administrative staff and UR coordinators, ensuring they have the training, tools, and resources needed to perform effectively.
• Develop, implement, and refine UM workflows and processes in collaboration with UM Managers and staff to improve efficiency and accuracy.
• Ensure timely and accurate completion of utilization data, including episodes, bed board reporting, census submissions, and leadership-requested metrics (e.g., no-show rates, APA, unpaid claims).
• Maintain advanced knowledge of the electronic health record (EHR) system; collaborate closely with the EHR Administrator to remain current on system updates and training.
• Partner with Accounting, Billing, and Utilization teams to ensure EHR data accuracy, proper billing, and claims integrity.
• Ensure medical necessity documentation meets payer and regulatory requirements and that UR clinical and financial authorizations are current in the EHR.
• Serve as an active member of the management team by identifying challenges, proposing solutions, supporting colleagues, and assisting staff as needed.
• Provide coverage for UM/UR functions during staff absences to ensure continuity of operations.
• Support onboarding, training, program expansion, and management of sensitive information in collaboration with UM leadership.
• Ensure accurate and complete payroll for the program.
• Maintain current knowledge of Medicaid, Medicare, CMS, and private insurance regulations related to utilization review.
• Manage utilization databases and reporting systems.
• Assist with budget preparation, expenditure requests, and fiscal planning.
• Build and maintain strong relationships with Managed Care Organizations (MCOs) and Administrative Service Organizations (ASOs).
• Ensure staff are informed of utilization requirements and contract changes related to authorizations, continued stays, and discharges.
• Oversee tracking of intake and discharge requirements per contract.
• Collaborate with clinical, utilization, and accounting teams to resolve authorization issues, denials, and appeals.
• Ensure timely submission of appeals with appropriate clinical and payer documentation.
• Maintain access to payer portals and manage required submissions.
• Chair or attend staff meetings and actively participate in planning, coordination, and communication efforts.
• Communicate clearly and professionally with residents, program staff, finance teams, payers, service providers, and community partners.
• Promote a collaborative, team-oriented work environment and function effectively within interdisciplinary teams.
• Maintain confidentiality and model professionalism in all interactions.
• Deliver excellent customer service to payers, vendors, and internal stakeholders.
• Participate in agency supervision and professional development activities.
• Provide training and supervision to UM administrators and UR coordinators.
• Ensure compliance with required training standards, including WAC and annual training plans.
• Develop and maintain training plans and training records for supervised staff.
• Develop, implement, and oversee UM audit processes.
• Ensure quality of care meets or exceeds State of Washington regulations and accreditation or contractual standards.
• Adhere to professional and ethical standards for behavioral health and substance use services.
• Participate in data collection and quality improvement initiatives.
• Establish, update, and maintain UM policies, procedures, and manuals to support quality, compliant, and cost-effective care.
• Stay current on industry best practices and regulatory changes.

What you'll bring

• Associates Degree in health care, business or related field or 4 years’ experience in Utilization Management/Medical Administration.
• 2 years of responsible leadership experience in management or supervisory positions

• 4 years of experience working with individuals with behavioral health conditions
• Knowledge of psychiatric/behavioral health systems and Utilization Management

Preferably you'll bring

• 1-year experience in SUD, Medical or MH fields with licensure
• Bachelor’s degree or higher in health care, business or related field
• Medical Coding/Billing Experience

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. EEOC is the Law/EEO Policy Statement

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.