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 investig