Nurse Consultant I

Health & Human Services; Burke (VA); On-site; USD 62,000 - 102,000; Full time

Job summary

The North Carolina Department of Health and Human Services (DHHS) invites applications for a Nurse Consultant I (NS) at Broughton Hospital. The role focuses on utilization review, performing initial, continued stay, and retrospective reviews to ensure medical necessity and compliance with federal/state regulations and insurer requirements.

You will work with Medicare/Medicaid and insurers, advising on documentation quality and level-of-care standards, while supporting data collection for

Qualifications

• Bachelor of Science in Nursing (BSN) preferred.
• RN license in North Carolina required.
• Two+ years of direct-care experience in a psychiatric setting preferred.
• Experience reviewing client medical records and collaboration across disciplines.
• Ability to discuss clinical information with patients, families, and authorized representatives.

Responsibilities

• Perform initial, continued stay, and retrospective reviews.
• Prepare and submit appeal requests as needed.
• Guide documentation quality, patient acuity, and level-of-care standards.
• Collaborate with Medicare, Medicaid, and commercial insurers.
• Support data collection and reporting for department and UR committee.

Skills

BSN

Psychiatric care

Medical records review

Interdisciplinary collaboration

Care discussions

Education

RN license

North Carolina RN

Job description

Agency Dept of Health and Human Services Division Broughton Hospital Job Classification Title Nurse Consultant I (NS) Position Number 65020925 Grade MH16

About Us

The North Carolina Department of Health and Human Services (DHHS) is one of the largest, most complex agencies in the state, and has approximately 17,000 employees. It is responsible for ensuring the health, safety, and well-being of all North Carolinians, providing human service needs for special populations including individuals who are deaf, blind, developmentally disabled, and mentally ill, and helping poor North Carolinians achieve economic independence.

Description of Work

Broughton Hospital is seeking a detail‑oriented and collaborative Nurse Consultant to join our Utilization Review (UR) Department. In this role, you will perform initial, continued stay, and retrospective reviews and prepare and submit appeal requests as needed. Your work ensures that services delivered are medically necessary, supports optimal reimbursement, and maintains compliance with federal and state regulations, accrediting bodies, and internal policies. You will work closely with Medicare, Medicaid, and commercial insurers to complete timely clinical reviews. In addition, you will serve as a resource to interdisciplinary team members by providing guidance on documentation quality, patient acuity, and level‑of‑care standards. The position also supports data collection and reporting for the Department of Operated Health Facilities, hospital leadership, and the Utilization Review Committee. The standard work schedule is Monday through Friday, 7:00 a.m. to 4:00 p.m. Some flexibility may be required for training or to meet operational needs.

Knowledge Skills and Abilities/Management Preferences

The Knowledge, Skills, and Abilities (KSAs)/ Management Preferences are not required. Applicants who possess the following skills are preferred:

• Experience reviewing client medical records and charts
• Experience collaborating with various disciplines and departments within an organization
• Experience discussing clinical or care‑related information with patients, families, and authorized representatives
• Bachelor of Science in Nursing (BSN)
• Two or more years of direct‑care experience in a psychiatric setting

Recruitment Range

$62,044 - $102,371

Conditional Requirements

Selected applicants must be able to pass a State Bureau of Investigation Criminal History Check, and complete and pass BLS/CPR training and Crisis Prevention Intervention (CPI) training during orientation. This Position Is Designated As Mandatory And Must Report Or Stay Over During Adverse Weather Events.

About the Facility:

Broughton Hospital is one of the three regional psychiatric hospitals with statutory responsibility for operating as part of the Division of State Operated Healthcare Facilities (DSOHF). With the North Carolina Department of Health and Human Services, we provide help and support to North Carolinians, and their families, experiencing mental illness. Our hospital serves the western thirty‑seven (37) counties of North Carolina, as part of the state's system of care and treatment for persons with mental illness.

Supplemental Contact Information:

DHHS uses the Merit‑Based Recruitment and Selection Plan to fill positions subject to the State Human Resources Act with the most qualified individuals. Hiring salary will be based on relevant qualifications, internal equity, and budgetary considerations pertinent to the advertised "position". Positions in the Division of State Operated Healthcare Facilities shall be subject to pre‑employment drug testing and criminal record background checks. Also, the use of tobacco products of any kind including vapor products are prohibited from our campuses. All employees are required to adhere to the facility's Vaccination Policy.

Minimum Education and Experience

Some state job postings say you can qualify by an “equivalent combination of education and experience.” If that language appears below, then you may qualify through EITHER years of education OR years of directly related experience, OR a combination of both. See the Education and Experience Equivalency Guide for details. Licensed to practice as a Registered Nurse in the State of North Carolina and one year of experience in the area of specialization.

EEO Statement

The State of North Carolina is an Equal Employment Opportunity Employer and dedicated to providing employees with a work environment free from all forms of unlawful employment discrimination, harassment, or retaliation. The state provides reasonable accommodation to employees and applicants with disabilities; known limitations related to pregnancy, childbirth, or related medical conditions; and for religious beliefs, observances, and practices.

Recruiter

Recruiter: Tandrea Lanae Jones Contact: DHHS Workday Support Form North Carolina State Government is one of the state’s largest employers, with over 76,000 employees all working toward a common goal: a safer and stronger North Carolina. We are a large organization comprised of various agencies, offices, and universities, each providing important public services. Eligible state employees are entitled to comprehensive benefits, including a variety of leave options, professional development opportunities, insurance, and more. To learn more about the benefits of being a North Carolina state employee, visit the N.C. Office of State Human Resources' website. Permanent, temporary, and time‑limited state government jobs can be found from the mountains to the coast. Find your next opportunity today! State Application Resources/Frequently Asked Questions Valuing Education and Experience The State of North Carolina values the knowledge and experience of our jobseekers and current state employees. Approximately 91 percent of state job classifications allow experience to be substituted for education or do not require a post‑secondary degree. Learn more about how you may qualify for a position through education or directly related experience, or a combination of both, with the Education and Experience Equivalency Guide. All job postings close at 11:59pm the night before the End Date on the posting. Introduce yourself to our recruiters and we'll get in touch if there's a role that seems like a good match. If you are already a state employee, please search for jobs by clicking here.