Nurse Consultant I

State of North Carolina; North Carolina; On-site; USD 62,000 - 102,000; Full time

Job summary

State of North Carolina’s Dept of Health and Human Services, Broughton Hospital, seeks a Nurse Consultant I to join the Utilization Review team. You will conduct initial, continued stay, and retrospective reviews, prepare appeals, and work with insurers to ensure medical necessity, proper reimbursement, and regulatory compliance. A Monday–Friday 7:00 a.m.

to 4:00 p.m. schedule is typical, with occasional flexibility for training.

Qualifications

• Licensed to practice as a Registered Nurse in the State of North Carolina and one year of experience in the area of specialization.
• Two or more years of direct-care experience in a psychiatric setting.

Responsibilities

• Perform initial, continued stay, and retrospective reviews and prepare and submit appeal requests as needed.
• Ensure services are medically necessary, support optimal reimbursement, and maintain compliance with federal and state regulations, accrediting bodies, and internal policies.
• Collaborate with Medicare, Medicaid, and commercial insurers to complete timely clinical reviews.

Skills

Medical records review

Interdisciplinary collaboration

Clinical communication

Utilization Review knowledge

Education

BSN (Bachelor of Science in Nursing)

Registered Nurse license in NC

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

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.

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.

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:

Tandrea Lanae Jones

Contact:

DHHS Workday Support Form