Remote Utilization Management Nurse RN Care Coordination

Trillium-Health-Resources; North Carolina; Hybrid; USD 69,000 - 92,000; Full time

Benefits offered by this job

Health Insurance

Work-from-home options

401k with 5% employer match

Paid Time Off (PTO) and holidays

Job summary

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/developmental disabilities.

Our mission is to help individuals and families build strong foundations for healthy, fulfilling lives. Trillium Health Resources is an Equal Employment Opportunity (EEO) employer and a drug-free workplace.

Qualifications

• Associate's degree in Nursing and 2 years of Utilization Management/Review experience, including acute inpatient care (ER, ICU, Med-Surg).
• Active North Carolina Licensure as a Registered Nurse (RN).
• Must reside within North Carolina and be able to travel within catchment as required.

Responsibilities

• Conduct prospective, concurrent, and retrospective clinical reviews using established criteria.
• Assess medical necessity and level of care based on clinical information.
• 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

RN licensure

Education

Associate's degree in Nursing

Job description

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/developmental disabilities.

Our mission is to help individuals and families build strong foundations for healthy, fulfilling lives. Trillium Health Resources is an Equal Employment Opportunity (EEO) employer and a drug-free workplace.