Nurse Utilization Review Specialist

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

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