Nurse Manager, Utilization Management - Remote NC

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

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.