Nurse Utilization Review Specialist

State of North Carolina - Health & Human Services; North Carolina; On-site; USD 62,000 - 102,000; Full time

Job summary

State of North Carolina - Health & Human Services is seeking a detail‑oriented Nurse Consultant I to join the Utilization Review department at Broughton Hospital. The role conducts initial, continued stay, and retrospective reviews and may prepare appeal requests to ensure medical necessity and proper reimbursement.

You will collaborate with Medicare, Medicaid, and insurers, guiding documentation quality and patient care standards.

Qualifications

• BSN required and registered to practice in NC.
• Two+ years of direct-care experience in a psychiatric setting preferred.
• Experience reviewing client medical records and collaborating with multiple disciplines.

Responsibilities

• Perform initial, continued stay, and retrospective reviews.
• Prepare and submit appeal requests as needed.
• Ensure services are medically necessary and compliant with regulations.
• Guide documentation quality, patient acuity, and level-of-care standards.

Skills

Medical records review

Interdisciplinary collaboration

Clinical communication with patients/f

Education

BSN

Job description

State of North Carolina - Health & Human Services is seeking a detail‑oriented Nurse Consultant I to join the Utilization Review department at Broughton Hospital. The role conducts initial, continued stay, and retrospective reviews and may prepare appeal requests to ensure medical necessity and proper reimbursement.

You will collaborate with Medicare, Medicaid, and insurers, guiding documentation quality and patient care standards.