Nurse Manager, Utilization Management– Physical Health

Trillium Health Resources; Raleigh (NC); Remote; USD 79,000 - 105,000; Full time

Benefits offered by this job

Health Insurance with no premium for员工

Work-from-home options

24 days Paid Time Off + 12 holidays

NC Local Government Retirement Pension

401k with 5% employer match

Public Service Loan Forgiveness (PSLF)

Remote work supplies stipend

Job summary

Trillium Health Resources in North Carolina is hiring a Nurse Manager, Utilization Management – Physical Health to lead day-to-day utilization management operations and oversee authorization workflows. The role requires clinical oversight, staff guidance, and ensuring timely determinations with standard review practices.

Qualified candidates will have RN licensure in NC, either an Associate's or Bachelor's degree in Nursing, and experience in utilization review or health plan operations.

Qualifications

• Active North Carolina RN licensure is required.
• Experience in utilization review, utilization management, or prior authorization.
• Experience with clinical acute inpatient care (ER, ICU, Med-Surg), post-acute care, health plan operations, and/or behavioral health is preferred.

Responsibilities

• Lead daily utilization management operations and authorization workflows.
• Monitor staff performance and ensure timely determinations.
• Review cases to ensure consistent application of criteria and policies.
• Resolve provider concerns and escalations related to authorizations.

Skills

RN Licensure (NC)

Utilization Review Experience

Education

Associate's degree in Nursing

Bachelor's degree in Nursing

Equivalent combination of education and experience

Job description

Pay Plan Title:

NurseManager, Utilization ManagementWorking Title:

Nurse Manager, Utilization Management – Physical HealthCost Center:

4700/ Utilization ManagementFLSA Status:

ExemptPosting Salary Range:

$78,624 - $105,158Office 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 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.

• 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
• NC Local Government Retirement Pension (defined-benefit plan) 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

• 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;
• 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;
• 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

Deadline for Application

October 12, 2026 at 11:59 PM

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.