Title: Utilization Review Coordinator
State Role Title: Health Care Compliance Spec II
Hiring Range: starting at $67,000 (commensurate based on experience)
Pay Band: 5
Agency: Dept Behavioral Health/Develop
Location: Western State Hospital
Agency Website: https://www.wsh.dbhds.virginia.gov/
Recruitment Type: General Public - G
Job Duties
Western State Hospital is seeking a dedicated and detail-oriented Utilization Review Coordinator to oversee the day-to-day operations of our Utilization Management Program. This role plays a critical part in ensuring compliance with state and federal regulations while supporting patient care and hospital efficiency.
Key Responsibilities:
- Conduct concurrent reviews of admissions and continued-stay patients.
- Ensure compliance with CMS guidelines for Notices of Non-Coverage.
- Coordinate Utilization Management Committee activities.
- Serve as a liaison between hospital staff and external review organizations.
- Facilitate timely notifications with the Reimbursement department to support revenue cycle processes.
- Monitor and coordinate hospital-wide resource utilization.
- Collaborate with managed care contracts to maximize certification and reimbursement.
- Route utilization review correspondence to Corporate Compliance and Reimbursement in a timely and accurate manner.
- Respond to external survey reports with appropriate action plans.
- Work closely with medical and professional staff to ensure adherence to UR requirements and minimize admission denials.
- This position requires strong communication and organizational skills, as well as the ability to work collaboratively across departments.
Compensation and Benefits:
- Starting salary: $67,000 for candidates with a background as an LPN, a Social worker, or a related field. (Salary for RN will be adjusted based on Degree, Licensure, and Experience)
- Retirement plan with cash match
- Paid time off, including sick, personal, and community service leave
- Health, dental, and vision insurance
- Life insurance
Minimum Qualifications
- Clinical experience as a Registered Nurse, Licensed Practical Nurse, Social Worker or related field in an acute care, intermediate care of skilled care facility or other combination of related training/experience *Candidates with an RN degree, RN experience, and an active RN license will receive credit for their degree and relevant experience. We also welcome applicants with backgrounds in LPN, social work, or other related fields*
- Knowledge of medical and psychiatric terminology and treatment procedures and practices, federal Medicare and state Medicaid regulations and Utilization Management activities are essential
- Ability to use Word processing, spreadsheet, and database programs to enter, manipulate and report
- Ability to work independently and effectively with other hospital staff.
- Knowledge of medical and psychiatric terminology and treatment procedures and practices, federal Medicare and state Medicaid regulations and Utilization Management activities.
- Experience in working with medical records and interfacing with Medicaid, Medicare, and private insurance companies is preferred. Knowledge of medical coding preferred.
- Ability to use Word processing, spreadsheet, and database programs to enter, manipulate and report data is required.
- Ability to communicate effectively verbally and in writing.
- Ability to interpret a variety of technical materials.
- Familiarity with the basic principle of continuous quality improvement and methods for their implementation and must possess good organizational skills
Additional Considerations
- Ability to work independently and effectively with other hospital staff.
- Knowledge of medical and psychiatric terminology and treatment procedures and practices, federal Medicare and state Medicaid regulations and Utilization Management activities.
- Experience in working with medical records and interfacing with Medicaid, Medicare, and private insurance companies is preferred. Knowledge of medical coding preferred.
- Ability to use Word processing, spreadsheet, and database programs to enter, manipulate and report data is required.
- Ability to communicate effectively verbally and in writing.
- Ability to interpret a variety of technical materials.
- Familiarity with the basic principle of continuous quality improvement and methods for their implementation. Must possess good organizational skills
- Bilingual
- Veteran or veteran spouse
Special Instructions
You will be provided a confirmation of receipt when your application and/or résumé is submitted successfully. Please refer to “Your Application” in your account to check the status of your application for this position.
The successful applicant must pass a criminal background investigation, drug screening test and employment reference check. The applicant must have the ability to perform at the level of physical demands noted on the Employee Work Profile and the verified ability to perform the essential functions of the position.
Commonwealth’s Alternate Hiring Process: In support of the Commonwealth’s commitment to inclusion, we are encouraging individuals with disabilities to apply through the Commonwealth Alternative Hiring Process. To be considered for this opportunity, applicants will need to provide their Certificate of Disability (COD) provided by a Vocational Rehabilitation Counselor within the Department for Aging & Rehabilitative Services (DARS), or the Department for the Blind & Vision Impaired (DBVI). Veterans are encouraged to answer Veteran status questions and submit their disability documentation, if applicable, to DARS/DBVI to get their Certificate of Disability. If you need to get a Certificate of Disability, use this link: https://www.vadars.org/drs/cpid/PWContact.aspx, or call DARS at 800- 552-5019, or DBVI at 800-622-2155.
DBHDS is a healthcare organization and must comply with the federal CMS Omnibus COVID-19 Health Care staff Vaccination Regulation which requires all employees to be vaccinated or receive an exemption. Upon acceptance of a job offer, new recruits will be asked to disclose their vaccination status (and for those fully vaccinated, proof of vaccination) during the pre-employment process. New staff who are not vaccinated for any reason or choose not to disclose their vaccination status, will need to request a medical or religious accommodation. If you have questions, please contact the Office of Human Resources.
Contact Information
Name: Samantha Leep
Phone: 540-332-8306
Email: samantha.leep@dbhds.virginia.gov
In support of the Commonwealth’s commitment to inclusion, we are encouraging individuals with disabilities to apply through the Commonwealth Alternative Hiring Process. To be considered for this opportunity, applicants will need to provide their AHP Letter (formerly COD) provided by the Department for Aging & Rehabilitative Services (DARS), or the Department for the Blind & Vision Impaired (DBVI). Service-Connected Veterans are encouraged to answer Veteran status questions and submit their disability documentation, if applicable, to DARS/DBVI to get their AHP Letter. Requesting an AHP Letter can be found at AHP Letter or by calling DARS at 800-552-5019.
Note: Applicants who received a Certificate of Disability from DARS or DBVI dated between April 1, 2022- February 29, 2024, can still use that COD as applicable documentation for the Alternative Hiring Process.