Nurse Manager, Utilization Management– Physical Health

Trillium Health Resources; North Carolina; Hybrid; USD 79,000 - 105,000; Full time

Benefits offered by this job

Work-from-home options

Competitive benefits

Paid time off and holidays

Job summary

Trillium Health Resources in North Carolina is seeking a Nurse Manager for Utilization Management – Physical Health to lead day-to-day utilization management operations and oversee clinical review workflows.

This role ensures timely authorizations, monitors performance, and directs staff to apply clinical criteria and NC Medicaid policies. The position supports work-from-home options for many roles and requires NC residency with travel as needed.

Qualifications

• ADN with 3 years RN utilization review in acute care settings.
• BSN with 1 year RN utilization review in acute care.
• Equivalent mix of education and experience accepted.
• Active North Carolina RN license.
• Valid driver's license and NC residency; travel within catchment.
• Experience with InterQual or NC Medicaid policies is preferred.

Responsibilities

• Lead daily utilization management workflows and authorization processing.
• Manage staff workload to ensure timely authorizations.
• Monitor turnaround times, decision accuracy, and documentation quality.
• Provide clinical guidance on escalated authorization issues.
• Resolve provider concerns and related escalations.

Skills

RN utilization review

Utilization management

Clinical review

Supervisory experience

Medicaid experience

Education

Associate's degree in Nursing

Bachelor's degree in Nursing

Equivalent combination of education and experience

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Full Time Officials & Admin *Trillium office based location as specified below: US 2 Attachments

Salary Range: $78,624.00 To $105,158.00 Annually

FLSA Status: Exempt

Posting Salary Range: $78,624 - $105,158

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 ?

• 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 Nurse Manager, Utilization Management – Physical Health to join our team! The Nurse Manager, Utilization Management – Physical Health leads day-to-day utilization management operations and oversees utilization management teams responsible for authorization and clinical review workflows. The role is accountable for performance monitoring, staff guidance, and manages workflow execution to ensure timely, accurate determinations and consistent application of review standards.

On a typical day, you might:

• Lead utilization management teams and oversee daily authorization workflows, including intake, review coordination, and determination processing.
• Manage staff workload to ensure timely completion of authorization activities.
• Monitor turnaround times, decision accuracy, and documentation quality across the team.
• Review cases and decisions to ensure consistent application of clinical criteria and policies.
• Provide clinical guidance and direction to staff on complex or escalated authorization issues.

Resolve provider concerns, complaints, and authorization-related escalations.

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
• 401k with 5% employer match and immediate vesting
• Public Service Loan Forgiveness (PSLF) qualifying employer
• Quarterly stipend for remote work supplies

Qualifications

Required:

• Associate's degree in Nursing and three (3) years of experience as an RN in utilization review, utilization management, or prior authorization, to include experience in clinical acute inpatient care (ER, ICU, Med-Surg), post-acute care, health plan operations, and/or behavioral health; OR
• Bachelor's degree in Nursing and one (1) year of experience as an RN in utilization review, utilization management, or prior authorization, to include experience in clinical acute inpatient care (ER, ICU, Med-Surg), post-acute care, health plan operations, and/or behavioral health; OR
• Equivalent combination of education and experience.
• Active North Carolina Licensure as a Registered Nurse (RN).
• Must have a valid driver’s license.
• Must reside within North Carolina.
• Must be able to travel within catchment as required.

Preferred:

• Supervisory experience of two (2) or more employees
• Previous working experience with Medicaid

Experience with InterQual guidelines and/or NC Medicaid Clinical Coverage Policies

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.

Attachments (2)

Tips for Applying to or Interviewing with Trillium 2.3.26 .pdf