Nurse Consultant I
About The Position
Broughton Hospital is seeking a detail-oriented and collaborative Nurse Consultant to join its Utilization Review (UR) Department. The role performs initial, continued-stay, and retrospective reviews and prepares and submits appeal requests as needed. It helps ensure services are medically necessary, supports optimal reimbursement, and maintains compliance with federal and state regulations, accrediting bodies, and internal policies. The Nurse Consultant works with Medicare, Medicaid, and commercial insurers to complete timely clinical reviews and serves as a resource to interdisciplinary team members 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 schedule is Monday through Friday, 7:00 a.m. to 4:00 p.m. Some flexibility may be required for training or operational needs. The position is designated mandatory and must report or stay over during adverse weather events.
Requirements
- Be licensed to practice as a Registered Nurse in the State of North Carolina.
- Have one year of experience in the area of specialization.
- Pass a State Bureau of Investigation Criminal History Check.
- Complete and pass BLS/CPR training and Crisis Prevention Intervention (CPI) training during orientation.
- Undergo pre-employment drug testing and criminal record background checks.
- Adhere to the facility's Vaccination Policy.
Nice To Haves
- 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 utilization reviews.
- Prepare and submit appeal requests as needed.
- Work with Medicare, Medicaid, and commercial insurers to complete timely clinical reviews.
- Provide interdisciplinary team members guidance on documentation quality, patient acuity, and level-of-care standards.
- Support data collection and reporting for the Department of Operated Health Facilities, hospital leadership, and the Utilization Review Committee.
- Report or stay over during adverse weather events as required for this mandatory position.
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
