Nurse Consultant II

Health & Human Services; North Carolina; Hybrid; USD 67,000 - 110,000; Full time

Benefits offered by this job

Health insurance

Retirement plans

Paid time off

Hybrid work option

Job summary

The North Carolina Department of Health and Human Services (NCDHHS) is seeking a licensed Registered Nurse with Medicaid policy expertise to analyze and maintain coverage policies, review complex requests, and support policy interpretation for program implementation. The role emphasizes collaboration with managed care plans, providers, and internal staff to improve policy accuracy and outcomes.

The position offers a hybrid work option, competitive compensation, and access to comprehensive state

Qualifications

• Experience researching, analyzing, and interpreting complex Medicaid policies, regulations, standards, and guidance.
• Ability to develop clear, actionable recommendations for policy and program decisions.
• Strong written and verbal communication tailored to diverse audiences.

Responsibilities

• Develop and maintain Medicaid coverage policies through analysis and evaluation.
• Review claims, coverage requests, and inquiries to inform decisions.
• Collaborate with plans, providers, and staff to ensure policy implementation.
• Evaluate trends and data to inform policy recommendations and operational improvements.
• Provide guidance to providers and stakeholders on Medicaid policies and requirements.

Skills

Policy analysis

Medicaid policies

Regulatory interpretation

Stakeholder communication

Organizational skills

Education

Registered Nurse license (NC)

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.

Key Duties Include:

• Develop and maintain Medicaid coverage policies through clinical analysis, policy review, and evaluation of reimbursement and medical necessity issues.
• Conduct policy and regulatory research to ensure alignment with state and federal requirements and support implementation of policy updates.
• Review complex claims, coverage requests, and provider inquiries to verify compliance and inform program decisions.
• Collaborate with managed care plans, providers, and internal staff to support policy interpretation and consistent program implementation.
• Evaluate healthcare trends and program performance data to inform policy recommendations and operational improvements.
• Support development of reimbursement methodologies by analyzing clinical and programmatic information relevant to Medicaid services.
• Provide guidance and education to providers and stakeholders to promote understanding of Medicaid policies, requirements, and procedural updates.
• Assist with implementation of coding and program changes by reviewing technical guidance and coordinating with relevant partners.
• Participate in quality assurance activities that strengthen policy accuracy, regulatory compliance, and program operations.
• Address provider concerns through targeted analysis, issue resolution, and development of clear, actionable recommendations.

Knowledge Skills and Abilities/Management Preferences

Salary Grade Range: $66,696.00 - $110,049.00

Recruitment Range: $66,696.00 - $87,715.00

Applicants who possess the following skills are preferred:

• Demonstrated experience researching, analyzing, and interpreting complex Medicaid policies, regulations, standards, and technical guidance to develop clear, actionable recommendations.
• Documented success developing, reviewing, and maintaining professional documents such as policies, procedures, reports, guidance materials, and stakeholder communications.
• Proven effectiveness communicating complex clinical and policy information through clear written materials and concise verbal explanations tailored to diverse audiences.
• Established experience collaborating with internal and external stakeholders to gather information, build consensus, resolve issues, and support implementation of new processes or initiatives.
• Demonstrated strong organizational and analytical skills, including managing multiple priorities, meeting deadlines, and completing work independently with minimal supervision.

This Position Will Close At 11:59 P.M. The Night Before The End Date.

This Position Is Eligible For A Hybrid Work Option EHRA: Per G.S. 126-5(c1) (37), This Position Is EXEMPT From All Provisions Of NC General Statute Chapter 126 (State Human Resources Act) With The Exception Of Articles 6 And 7 RN License Must Be Provided On The Application.

About the NC Division of Health Benefits

The Division of Health Benefits (DHB) within NCDHHS is committed to advancing innovative solutions that improve health, promote well-being and foster independence for all North Carolinians. DHB manages and oversees North Carolina Medicaid and other programs that provide access to services and supports for parents, children, seniors, people with intellectual / developmental disabilities, and behavioral health, substance use and traumatic brain injury disorders. With a budget over $27 billion in state and federal funds per fiscal year, DHB ensures that more than 108,000 enrolled providers are reimbursed for delivering covered services to 3.1 million beneficiaries. All positions in the Division of Health Benefits are exempt from the State Human Resources Act (G.S. 126) except for the provisions of Articles 6 and 7 per HB 372 Section 20.

Compensation and Benefits: The State of North Carolina offers excellent comprehensive benefits. Employees can participate in health insurance options, standard and supplemental retirement plans, and the NCFlex program (numerous high-quality, low-cost benefits on a pre-tax basis). Employees also receive paid vacation, sick, and community service leave. In addition, paid parental leave is available to eligible employees. Visit the website for State Benefits.

Minimum Education and Experience

Licensed to practice as a Registered Nurse in the State of North Carolina and two years of clinical 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.

All job postings close at 11:59pm the night before the End Date on the posting.

Applicants may be subject to a criminal background check. All candidates selected for positions considered "Positions of Trust" will be subject to a criminal background check.