The Monongahela River Basin has an extensive history of fossil fuel development, including coal mining and natural gas extraction. In late summer 2008, total dissolved solids (TDS) concentrations exceeding the United States Environmental Protection Agency′s (EPA) secondary drinking water standards were detected. After determining the source, a voluntary discharge management plan (VDMP) was developed by the West Virginia Water Research Institute (WVWRI) and implemented by the coal industry (2010). Additional remediation actions included Pennsylvania’s prohibition of produced wastewater in publicly owned treatment facilities (2011) and construction of a reverse osmosis treatment facility (2013). We used a locally weighted polynomial regression in conjunction with a segmented regression to assess the discharge and concentration trends/changepoints for bromide, chloride, sulfate, and total dissolved solids at various locations relative to the three remedial actions. We detected significant (α < 0.05) positive trends for discharge and significant negative trends for bromide, chloride, sulfate, and total dissolved solids. In conjunction, we also detected 1–4 changepoints within each model. Additionally, a linear mixed effects model containing discharge and remedial actions was used to measure the effectiveness of each remediation action in reducing TDS over time. Of the three remedial actions, the VDMP by itself was effective in maintaining river sulfate and TDS levels below the secondary drinking water standards (−0.12, p-value = 0.002). The combination of the VDMP with Pennsylvania’s produced water prohibition (−0.16, p-value < 0.001) and the combination of the VDMP with the reverse osmosis treatment facility (−0.19, p-value < 0.001) were also effective. The use of all three remedial actions produced the strongest effect (−0.37, p-value < 0.001) Since the implementation of these changes, primarily the VDMP which encompasses most of the watershed, TDS in the Monongahela has not exceeded the EPA′s secondary drinking water standards. Future management decisions should include efforts to further expand the VDMP and to monitor changes in land use or severe changes in discharge.