Remote Utilization Management Specialist III – IDD

Trillium Health Resources; Boone (NC); Hybrid; USD 69,000 - 92,000; Full time

Benefits offered by this job

Work-from-home options

Health insurance with no premium

Flexible Spending Accounts

PTO + holidays

401k with employer match

Job summary

Trillium Health Resources is seeking an Utilization Management Specialist III – IDD to review service authorization requests and determine appropriate care levels. You will apply medical necessity criteria and provide clinical consultation to ensure quality decisions.

The role requires a Master’s degree in health and human services, NC licensure (LCSW/LCMHC/LMFT/LPA/LCAS/RN), and the ability to travel within North Carolina. Remote work options are available for many positions.

Qualifications

• 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).
• Valid driver’s license required.
• Must reside in North Carolina and be able to travel within the catchment.

Responsibilities

• Evaluate authorization requests to determine medical necessity and level of care.
• Approve, modify, or deny services based on criteria and guidelines.
• Interpret clinical documentation, diagnoses, and treatment plans.
• Provide clinical consultation to providers and internal teams.
• Perform clinical triage and guide referral decisions.
• Participate in appeals, mediations, hearings, and post-service reviews.

Skills

Active NC licensure

Driver's license

Education

Master's degree in health and human services

Job description

Trillium Health Resources is seeking an Utilization Management Specialist III – IDD to review service authorization requests and determine appropriate care levels. You will apply medical necessity criteria and provide clinical consultation to ensure quality decisions.

The role requires a Master’s degree in health and human services, NC licensure (LCSW/LCMHC/LMFT/LPA/LCAS/RN), and the ability to travel within North Carolina. Remote work options are available for many positions.