Director, Utilization Management — Remote Leader

Socket.dev; Boone (NC); On-site; USD 118,000 - 164,000; Full time

Benefits offered by this job

Health Insurance with no premium for员工

Remote work options within NC

24 days PTO + 12 holidays

NC Local Government Retirement Pension

401k with 5% employer match

PSLF qualifying employer

Quarterly remote work stipend

Flexible Spending Accounts

Job summary

Trillium Health Resources is seeking a Director, Utilization Management to lead utilization review operations, ensure compliance, and drive performance across NC regions. You will set priorities, oversee workflows, and guide clinical review processes to support efficient, quality decisions.

The role requires RN or advanced licensure in NC, with UM experience and the ability to travel within the catchment. Remote within NC; strong leadership and analytics are essential for success.

Qualifications

• Bachelor's degree in Nursing or health and human services is required or
• Master's degree in Nursing or health and human services with UM experience
• Active NC licensure as listed (LCSW, LCMHC, LMFT, LPA, LCAS, RN) or equivalent

Responsibilities

• Direct utilization review operations, mostly post payment reviews, including authorization workflows and clinical review processes.
• Establish operational priorities and align team activities with organizational goals.
• Monitor performance metrics such as timeliness, accuracy, and consistency of decisions.
• Ensure standardized application of clinical criteria, policies, and review guidelines across teams.
• Oversee development and refinement of workflows, procedures, and review processes.
• Review paid claims to ensure code congruence with paid claims.

Skills

Utilization Management experience

Leadership

Travel readiness

Education

Bachelor's degree in Nursing or health and human services

Master's degree in Nursing or health and human services

Job description

Trillium Health Resources is seeking a Director, Utilization Management to lead utilization review operations, ensure compliance, and drive performance across NC regions. You will set priorities, oversee workflows, and guide clinical review processes to support efficient, quality decisions.

The role requires RN or advanced licensure in NC, with UM experience and the ability to travel within the catchment. Remote within NC; strong leadership and analytics are essential for success.