Director, Utilization Management – Review

Socket.dev; Boone (NC); Hybrid; 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

Pay Plan Title: Director, Utilization Management

Working Title: Director, Utilization Management – Review

FLSA Status: Exempt

Posting Salary Range: $118,292 - $163,939

Office Location: Remote within North Carolina.

POSTING DETAILS:

Make an Impact

Trillium Health Resources is a Tailored Plan and Managed Care Organization (MCO) serving 46 counties across North Carolina. We manage services for individuals with serious mental health needs, substance use disorders, traumatic brain injuries, and intellectual/development (IDD) disabilities. Our mission is to help individuals and families build strong foundations for healthy, fulfilling lives.

Why Work for Us?

Trillium believes that empowering others begins with supporting our team. We offer our employees:

• A collaborative, mission-driven work environment
• Competitive benefits and work-from-home options for most positions
• Opportunities for professional growth in a diverse inclusive culture

Every day, our work changes lives – from children thriving through early intervention and school-based therapies, to adults with severe mental illness living independently and contributing to their communities.

What We’re Looking For

Trillium Health Resources has a career opening for a Director, Utilization Management to join our team! The Director, Utilization Management leads utilization review functions and is accountable for operational performance, quality, and compliance of clinical review activities. The role sets operational priorities, oversees workflows and performance, and drives process improvements to ensure consistent, efficient, and compliant authorization decisions.

On a typical day, you might:

• 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, including 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 appropriate code was enacted to be congruent with the paid claim.

Employee Benefits:

Trillium knows that work/life balance is essential. That’s why we offer:

• Typical working hours: 8:30 am – 5:00 pm; flexible work schedules available for some positions with management approval.
• Work-from-home options available for most positions
• Health Insurance with no premium for employee coverage
• Flexible Spending Accounts
• 24 days of Paid Time Off (PTO) plus 12 paid holidays in your first year
• NC Local Government Retirement Pension (defined-benefit plan) https://www.myncretirement.gov/systems-funds/local-governmental-employees-retirement-system-lgers/lgers-handbook
• 401k with 5% employer match and immediate vesting
• Public Service Loan Forgiveness (PSLF) qualifying employer
• Quarterly stipend for remote work supplies

Qualifications

Required:

• Bachelor's degree in Nursing or health and human services and three (3) years of Utilization Management experience; OR
• Master's degree in Nursing or health and human services and one (1) year of Utilization Management experience.
• Active North Carolina licensure as:
  • Licensed Clinical Social Worker (LCSW)
  • Licensed Clinical Mental Health Counselor (LCMHC)
  • Licensed Marriage and Family Therapist (LMFT)
  • Licensed Psychological Associate (LPA)
  • Licensed Clinical Addictions Specialist (LCAS)
  • Registered Nurse (RN)
• Must have a valid driver’s license.
• Must reside within North Carolina.
• Must be able to travel within catchment as required.

Deadline for Application:Tuesday, September 29, 2026 at 11:59pm

Trillium Health Resources is an Equal Employment Opportunity (EEO) employer and a drug-free workplace. All candidates must pass a drug test as a condition of employment.

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