Utilization Review Nurse Consultant
State of North Carolina
Full-time
On-site
Buncombe County, North Carolina, United States
$59,732 - $98,557 USD yearly
Registered Nurse
- Description of Work
This is an Internal Posting open ONLY for current employees of the NC Department of Health and Human Services and eligible RIF Candidates from NC State Government.
As of January 1, 2025, the new salary range will be $59,732 to $98,557
Are you a Registered Nurse looking to take the next step in your career progression? Do you want to make a difference while enjoying a set schedule? If so, please consider the Utilization Review Nurse Consultant position located at Julian F. Keith Alcohol and Drug Abuse Treatment Center (JFK-ADATC) in beautiful Black Mountain, NC, located 15 minutes away from downtown Asheville.
The primary responsibility of the Utilization Review Nurse Consultant (UR Nurse) is to ensure that clinically appropriate care, discharge and cost-effective utilization of services are maintained across the treatment continuum at the facility. The UR Nurse, in conjunction with the Utilization Review Committee, the Quality Assurance Coordinator, Director of Nursing, Clinical Program Director, CMO/Clinical Director, and CEO/Facility Director, provides ongoing clinical review of patients served at the facility – from admission through discharge. The UR Nurse takes the lead in assuring that admissions, continued stays, discharges, and appeals related to service provisions are reviewed and responded to in a timely and clinically sound manner in accordance with written policies of the governing body and the facility’s Utilization Management Plan. This position will also:
Follow policies and protocols defined by third party payers for patients entitled to benefits under the Medicare and Medicaid programs.
Handle clinical consultations with insurance carriers, managed care entities, and Quality Improvement Organizations for certification and re-certification of services.
Familiar with all aspects of beneficiary rights, quality improvement efforts, and payment and reimbursement issues.
Facilitates educational and training activities with clinical staff related to quality improvement efforts, risk management and areas related to patient safety and staff responsiveness.
About the facility:
JFK-ADATC is a 68-bed inpatient treatment facility designed to meet the needs of adults with substance use disorders from the 44 westernmost counties in North Carolina. The facility treats individuals with substance abuse and psychiatric diagnoses. We are accredited by the Joint Commission on Accreditation of Healthcare Organizations as a Behavioral Health facility and certified by the Centers for Medicare and Medicaid Services as an inpatient psychiatric hospital. Our treatment program focuses on individualized acute rehab services and detox/crisis stabilization. Coordination of treatment is provided through small interdisciplinary treatment teams consisting of representatives from counseling, nursing, recreation therapy, medical/psychiatric, psychological, social work, and substance abuse education departments.
About NC Department of Health and Human Services: The North Carolina Department of Health and Human Services (DHHS) serves the needs of the most vulnerable of North Carolinians and to accomplish this, we hire only the most dedicated and caring individuals. Finding qualified clinical professionals to treat and care for our clients is a continual challenge as demand for services grows and the availability of providers struggles to keep pace. We are seeking a motivated individual who is up for this challenge and is dedicated to our mission of providing North Carolinians with the very best in clinical care.
Compensation & Benefits: The State of North Carolina offers the BEST comprehensive benefits around! 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 our website for additional information on North Carolina State Employee Benefits and the available plans to choose from with minimal waiting periods!
This position will primarily work 8-hour days (8:00 am – 4:30 pm), Monday-Friday
This position is designated Mandatory and must report or stay over during adverse weather events.
**JFK-ADATC is an approved loan repayment facility with HRSA Nursing Corps and the STAR Program where employees can apply for programs
that will repay part or all of your outstanding student loan debt!**
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.- Knowledge, Skills and Abilities / Competencies
Candidates are qualified based upon the information submitted on the state job online application. Any information omitted from the application but included in an attachment, such as a resume, will not be considered as qualifying experience. PLEASE INCLUDE ALL Knowledge, Skills and Abilities IN THE BODY OF THE APPLICANTION.
Attached resumes are not permissible; please do not attach to the application. However, copy/paste from your resume into the body of the application is acceptable. Work history and education (as applicable for the position) must be included on the application. “See Resume or See Attachment” will not be accepted, nor is a text or attached resume accepted in lieu of a completed application. Please complete your application in full.
Qualified applicants must document on the application that they possess expertise on ALL of the following:
Technical Knowledge: considerable knowledge and skill in application of professional nursing theory, techniques and practices, preferably in areas of psychiatric and chemical dependency practices.
Critical Thinking: ability to gather, compile, and analyze data related to quality patient care.
Client/Customer Service: ability to approach job functions with opportunities to assist patients and improve delivery systems.
Consulting/Advising: skill and ability to consult with physicians, treatment team members, outside insurers, QIO organizations, etc. regarding treatments and procedures rendered and documentation of care.
Coaching/Mentoring: ability to instruct other staff members on patient care concerns, performance improvement efforts, and quality assurance activities.
Communication: ability to communicate with all levels of staff in a manner conducive to improved performance, enhanced systems operations, and positive corrective actions.
For tips on how to complete this online application, please visit https://oshr.nc.gov/work-for-nc/how-do-i-get-job.- Minimum Education and Experience Requirements
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 https://oshr.nc.gov/experience-guide for details.
Minimum Education and Experience:
Licensed to practice as a Registered Nurse in the State of North Carolina
One year of experience in Utilization Review
Management Preferences:One to two (1-2) years of experience in Utilization Review or UR Management.
A strong nursing background is preferred with ideally a focus and understanding of the particular needs of patients with co-occurring substance use and mental health disorders.- Supplemental and Contact Information
The North Carolina Department of Health and Human Services is an Equal Opportunity Employer. We encourage all qualified applicants to apply. This is a generalized representation of positions in this class and is not intended to identify essential functions per ADA.
Annual salary is determined based on competencies, equity, budget, and other salary administration considerations.
Degrees must be received from appropriately accredited institutions. Transcripts, degree evaluations and cover letters may be uploaded with your application. Applicants who obtained their education outside of the United States and its territories are expected to assume responsibility for having their academic degrees validated as equivalent to a degree conferred by a regionally accredited college or university in the United States.
Please make sure you complete the application in full. Resumes may be uploaded with your application but will not be accepted in lieu of a fully completed application and will not be considered for qualifying credit. "See Resume" or "See Attachment" will NOT be accepted. If multiple applications are submitted to an individual position, only the most recent application received prior to the posting closing date will be accepted. Applications must be submitted by 5:00 PM on the closing date.
All Division of State Operated Healthcare Facilities are a tobacco free environment. The use of tobacco products of any kind including vapor products are prohibited from our campus.
All employees are required to adhere to the facility’s Vaccination Policy.
All positions in the Division of State Operated Healthcare Facilities shall be subject to pre-employment drug testing and criminal record background checks.
Due to the volume of applications received, we are unable to provide information regarding the status of your application over the phone. To check the status of your application, please log in to your account. Communication with applicants regarding the status of their application will be via email only. You will either receive a call to schedule an interview or an email notifying you when the job has been filled.
For technical issues with your applications, please call the NeoGov Help Line at 855-524-5627. If there are any questions about this posting other than your application status, please contact Human Resources at 828-257-6238.