Utilization Review Coordinator

Title: Utilization Review Coordinator

State Role Title: 49172

Hiring Range: Starting Pay $81,000 (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 full time Utilization Review Coordinator who will be responsible for the day-to-day operation of the Utilization Management program at Western State Hospital, including concurrent review of admissions and continued-stay patients and other focused areas of review; will follow CMS guidelines for notices of Non-Coverage; the coordination of the Utilization Management Committee activities and performing as a liaison with hospital staff and outside review organizations; facilitates required notifications with Reimbursement to maximize timely revenue submissions' and monitors and helps coordinate hospital wide utilization of resources in compliance with state and federal regulations.

This position will also interact effectively with managed care contracts to maximize certification and subsequent reimbursement to the department; ensures correspondence relating to utilization review activities are routed to Corporate Compliance and Reimbursement as necessary in a timely and accurate manner; Responds to reports of external surveys with viable action plans as appropriate; and Serves as the primary person responsible for working closely with the medical/professional staff with regard to UR requirements for admission criteria, etc., and associated regulatory requirements in order to minimize admission denials.

This position is eligible for:

- retirement with cash match
- paid time off; sick/personal time; community service time
- health, vision, and dental 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
- 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.

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.