Utilization Review Coordinator

Virginia Information Technologies Agency•Staunton, VA

2d•$67,000•Onsite

About The Position

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.

Requirements

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.

Nice To Haves

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

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.