Nurse Manager, Utilization Mgmt — Physical Health (Remote)

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

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.