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
Location: Western State Hospital
103 Valley Center Drive, Staunton, VA 24401.
Who We Are
Western State Hospital, part of the Virginia Department of Behavioral Health and Developmental Services (DBHDS), has been a leader in psychiatric treatment since 1828. WSH is a 302-bed Joint Commission/CMS-accredited psychiatric facility located in the scenic Shenandoah Valley. Just 30 minutes from vibrant university towns, our hospital serves adults with serious mental health needs and is nationally recognized for our Psychosocial Rehabilitation “Learning” programs.
WSH provides a modern clinical setting and a therapeutic environment for patients, supported by highly qualified staff. Employees also enjoy the beauty and tranquility of the Shenandoah Valley, with nearby cities such as Charlottesville and Harrisonburg offering dining, entertainment, and outdoor activities, making Staunton an attractive place to live and work.
Position Overview:
Western State Hospital is seeking a full time 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
Special Instructions to Applicants:
Application Requirements: Applications and résumés for this position are accepted electronically through the Commonwealth of Virginia’s Electronic Recruitment System only. Interview decisions will be based solely on the information provided in your electronic application and/or résumé. Please ensure you clearly and specifically detail all relevant work experience; we will not make assumptions about your qualifications.
Background Investigation: All applicants are subject to an extensive background investigation and a pre-employment drug screening. This investigation may include fingerprint checks (State Police, FBI), local agency checks, Department of Social Services/Child Protective Services checks, employment verification, and verification of education relevant to the position.
Under Virginia Code §§ 37.2-314 and 37.2-408.1, the Department of Behavioral Health & Developmental Services (DBHDS) cannot employ or utilize as volunteers, individuals convicted of specific ("barrier") crimes or those with pending "barrier" charges.
Reasonable Accommodations: Reasonable accommodations are available to individuals with disabilities during the application and/or interview process in accordance with the Americans with Disabilities Act. If you require assistance or accommodation, please notify Human Resources at (540) 332-8300 during business hours (8:00 a.m. to 5:00 p.m.).
Equal Opportunity: The Commonwealth of Virginia is committed to conducting all aspects of human resource management without regard to race (or traits historically associated with race, including hair texture, hair type, and protective hairstyles such as braids, locks, and twists), sex, color, national origin, religion, sexual orientation, gender identity or expression, age, veteran status, political affiliation, disability, genetic information, and pregnancy, childbirth, or related medical conditions.* There shall be no retaliation against anyone making allegations of violations of this policy.
Veteran Preference: DBHDS is a Virginia Values Veterans (V3) certified employer and provides hiring preference to qualified veterans and service members. We strongly encourage veterans, active members of the Virginia National Guard, and U.S. Military Reserve members to apply to the state application and respond accordingly.
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 is required.
- 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 is required.
- Knowledge of medical and psychiatric terminology and treatment procedures and practices, federal Medicare and state Medicaid regulations and Utilization Management activities.
Additional Considerations
- Experience in working with medical records and interfacing with Medicaid, Medicare, and private insurance companies is preferred. Knowledge of medical coding preferred.
- Experience working in an inpatient psychiatric facility preferred.
- Veteran or veteran spouse
- Bilingual
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.