Remote Utilization Management Specialist II

Socket.dev; North Carolina; Hybrid; USD 56,000 - 70,000; Full time

Benefits offered by this job

Health insurance (employee)

Work-from-home options

Paid time off + holidays

NC retirement pension

401k with employer match

PSLF eligible employer

Remote work stipend

Job summary

Trillium Health Resources is seeking an Utilization Management Specialist II to validate service authorizations and manage workflow from intake through determination. The role ensures completeness, routes cases to clinical staff, and monitors timelines to support timely decision-making.

Qualifications include relevant MH/SU/IDD experience, a valid NC driver’s license, and NC residency with travel as required.

Qualifications

• Requires MH/SU/IDD experience at various education levels (HS, associate, bachelor)
• Must have a valid driver’s license
• Residency within North Carolina and ability to travel within catchment

Responsibilities

• Validate service authorization requests against benefit requirements prior to clinical review.
• Identify missing or inconsistent documentation and obtain required information from providers.
• Route complete requests to appropriate clinical reviewers based on service type and urgency.
• Monitor authorization timeframes and follow up to prevent delays in clinical review.
• Track determinations and ensure authorization status is accurately reflected in systems.

Skills

MH/SU/IDD experience

Driver's license

Education

High School Diploma/GED

Associate's degree

Bachelor's degree

Equivalent education/experience

Job description

Trillium Health Resources is seeking an Utilization Management Specialist II to validate service authorizations and manage workflow from intake through determination. The role ensures completeness, routes cases to clinical staff, and monitors timelines to support timely decision-making.

Qualifications include relevant MH/SU/IDD experience, a valid NC driver’s license, and NC residency with travel as required.