Clinical Review Specialist
Job no:
Work type: Full-Time (Salaried)
Location: Staunton, Virginia
Categories: Health and Human Services
Title: Clinical Review Specialist
State Role Title: Health Care Compliance Spec II
Hiring Range: Starting Pay from $77,234 - $106,583 per year
Pay Band: 4
Agency: Dept Behavioral Health/Develop
Location: Comm Ctr for Child & Adoles
Agency Website: https://dbhds.virginia.gov/facilities/ccca/
Recruitment Type: General Public - G
Job Duties
A. Evaluate delivery of care through Utilization Review (UR) Process
B. Data collection analysis and reporting.
C. Communicate with Medicaid and private insurance third party payers and regulatory agencies.
D. Employee Health responsibilities
Minimum Qualifications
• Psychiatric/clinical nursing expertise.
• Demonstrated knowledge of inpatient psychiatric treatment and documentation requirements to meet State and Federal Medicaid regulations.
• HIPPA and Compliance regulations
• Skilled in analyzing complex clinical documentation to identify discrepancies and recommends improvements, facilitating ongoing quality enhancement efforts
• Ability to communicate effectively, orally and in writing with clinicians, administrators, and patients, patients' families, and external agencies.
• Basic computer proficiency with typing, and knowledge of MS Word, and MS Excel
• Must possess ASN and active RN license.
Additional Considerations
• BSN Preferred
• Clinical delivery experience in an inpatient psychiatric setting required
• Prior experience in data management and analysis, utilization review, Medicaid and third party commercial insurances preferred.
• Experience with medical reviewers preferred
• Experience with Joint Commission standards preferred.
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.
Applicants must list all relevant experience that you wish to be considered for this position. Applicants will be provided confirmation of receipt when your application and/or resume is submitted. Please refer to "Your Application" in your account to check the status of your application for this position. A fingerprint-based criminal history check and reference checks are required for the selected candidate for this position. Under Virginia Code §37.2-314 and 37.2-408.1, the Department of Behavioral Health and Developmental Services is prohibited from employing or using as volunteers, persons who have been convicted of specific "barrier" crimes or persons who may be the subject of pending "barrier" charges.
DBHDS facilities are no longer required to ensure that all staff members are vaccinated against COVID-19. However, facilities encourage and educate staff on the benefits, and continue to offer COVID-19 vaccination programs to staff, residents/clients. Employees may be required to disclose immunization status for purposes of infection prevention and/or management of outbreaks. 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. If you have any questions, contact the Office of Human Resources.
Contact Information
Name: John Lee
Phone: 540-290-7795
Email: john.lee@dbhds.virginia.gov
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.
Advertised: 14 Oct 2026 Eastern Daylight Time
Applications close: 21 Oct 2026 Eastern Daylight Time
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