Nurse Consultant I

Adult Correction; North Carolina; On-site; USD 62,000 - 102,000; Full time

Job summary

Broughton Hospital, part of the North Carolina Department of Health and Human Services, seeks a detail‑oriented Nurse Consultant for the Utilization Review (UR) Department. You will perform initial, continued stay, and retrospective reviews and prepare appeal requests to ensure medical necessity and proper reimbursement.

You will collaborate with Medicare, Medicaid, and commercial insurers, support documentation quality, patient acuity, and level‑of‑care standards.

Qualifications

• 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.

Responsibilities

• Perform initial, continued stay, and retrospective reviews.
• Prepare and submit appeal requests as needed.
• Ensure services are medically necessary and support proper reimbursement.
• Collaborate with Medicare, Medicaid, and commercial insurers on clinical reviews.
• Support data collection and reporting for the UR Department.

Skills

Medical record review

Interdisciplinary collaboration

Clinical communication

BSN

Psychiatric care experience

Education

BSN

Job description

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

Recruitment Range $62,044 - $102,371

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

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.