Remote Utilization Management Nurse - Physical Health

NEPSE Trading; Northern (KY); Hybrid; USD 69,000 - 92,000; Full time

Benefits offered by this job

Health Insurance

Flexible Spending Accounts

Paid Time Off

Public Service Loan Forgiveness (PSLF)

401k with employer match

Job summary

Trillium Health Resources is seeking a Utilization Management Nurse – Physical Health to perform clinical reviews and coordinate care for members across North Carolina. This exempt, remote role supports discharge planning and ensures appropriate service use in a managed care setting.

The successful candidate holds an Associate's degree in Nursing with an active NC RN license and at least two years in UM/Review, including acute inpatient and behavioral health contexts.

Qualifications

• Associate degree in Nursing required.
• Active NC RN licensure required.
• Two years of Utilization Management/Review experience required, covering acute inpatient care (ER/ICU/Med-Surg), behavioral health, or evidence-based decision support.

Responsibilities

• Conduct prospective, concurrent, and retrospective clinical reviews using established criteria.
• Assess clinical information to determine medical necessity and level of care.
• Collaborate with providers and facilities to support treatment planning and discharge coordination.
• Perform admission and concurrent reviews to monitor ongoing care needs.
• Identify cases requiring physician review and present clinical recommendations.

Skills

Utilization Management

Clinical reviews

Travel flexibility

Education

Associate's degree in Nursing

Active North Carolina RN Licensure

Job description

Trillium Health Resources is seeking a Utilization Management Nurse – Physical Health to perform clinical reviews and coordinate care for members across North Carolina. This exempt, remote role supports discharge planning and ensures appropriate service use in a managed care setting.

The successful candidate holds an Associate's degree in Nursing with an active NC RN license and at least two years in UM/Review, including acute inpatient and behavioral health contexts.