Remote Utilization Management Specialist III

Trillium Health Resources; Raleigh (NC); Remote; USD 69.000 - 92.000; Vollzeit

Benefits dieser Stelle

Work-from-home options

Health Insurance

Paid Time Off

401k with employer match

Remote work stipend

Zusammenfassung

Trillium Health Resources is seeking an Utilization Management Specialist III - MH/SU to perform comprehensive clinical review of service requests for individuals with mental health, substance use, or related conditions. The role emphasizes timely decisions, documentation, and provider consultation.

The position requires a Master’s degree in a relevant field and active North Carolina licensure; travel within the NC catchment is expected. Remote work options are available for many roles.

Qualifikationen

• Master's degree in health and human services or related field and one year of Utilization Management experience.
• Active North Carolina licensure (LCSW, LCMHC, LMFT, LPA, LCAS, RN).
• Must reside within North Carolina and be able to travel within catchment.

Aufgaben

• Provide clinical review of services for members with mental health, substance use, and/or developmental disabilities including diagnosis review and medical necessity criteria.
• Determine member eligibility, level of care, and make service authorization decisions with clear documentation.
• Provide clinical triage for members seeking services and offer consultation to providers on care needs and scope of practice.
• Review and staff treatment documentation for group, family, or individual services.

Ausbildung

Master's degree in health and human services or related field

Licensed Clinical Social Worker (LCSW)

Licensed Clinical Mental Health Counselor (LCMHC)

Licensed Marriage and Family Therapist (LMFT)

Licensed Psychological Associate (LPA)

Licensed Clinical Addictions Specialist (LCAS)

Registered Nurse (RN)

Jobbeschreibung

Trillium Health Resources is seeking an Utilization Management Specialist III - MH/SU to perform comprehensive clinical review of service requests for individuals with mental health, substance use, or related conditions. The role emphasizes timely decisions, documentation, and provider consultation.

The position requires a Master’s degree in a relevant field and active North Carolina licensure; travel within the NC catchment is expected. Remote work options are available for many roles.