Utilization Management Nurse – Physical Health

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

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Full Time Professionals *Trillium office based location as specified below: US 2 Attachments

2 days ago Requisition ID: 3429

Salary Range: $68,890.00 To $92,138.00 Annually

FLSA Status: Exempt

Posting Salary Range: $68,890 - $92,138

Office Location: Remote within North Carolina.

POSTING DETAILS:

Make an Impact

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/development (IDD) disabilities. Our mission is to help individuals and families build strong foundations for healthy, fulfilling lives.

Why Work for Us ?

Trillium believes that empowering others begins with supporting our team. We offer our employees:

• Competitive benefits and work-from-home options for most positions
• Opportunities for professional growth in a diverse inclusive culture

Every day, our work changes lives – from children thriving through early intervention and school-based therapies, to adults with severe mental illness living independently and contributing to their communities.

If you are looking for a unique opportunity to make a tangible impact on the lives of others, apply today!

What We’re Looking For

Trillium Health Resources has a career opening for a Utilization Management Nurse to join our Utilization Management team! The Utilization Management Nurse performs clinical reviews and coordinates care to ensure appropriate use of services and effective care transitions. The role evaluates clinical information, collaborates with providers, and supports discharge planning to improve outcomes and continuity of care.

On a typical day, you might:

• Conducts prospective, concurrent, and retrospective clinical reviews using established criteria.
• Assesses clinical information to determine medical necessity and level of care.
• Collaborates with providers and facilities to support treatment planning and discharge coordination.
• Performs admission and concurrent reviews to monitor ongoing care needs.
• Identifies cases requiring physician review and presents clinical recommendations.

Employee Benefits:

Trillium knows that work/life balance is essential. That’s why we offer:

• Typical working hours: 8:30 am – 5:00 pm; flexible work schedules with some roles with management approval.
• Work-from-home options available for most positions
• Health Insurance with no premium for employee coverage
• Flexible Spending Accounts
• 24 days of Paid Time Off (PTO) plus 12 paid holidays in your first year
• 401k with 5% employer match and immediate vesting
• Public Service Loan Forgiveness (PSLF) qualifying employer
• Quarterly stipend for remote work supplies

Qualifications

Required:

• Associate's degree in Nursing and two (2) years of Utilization Management/Review, to include clinical acute inpatient care (ER, ICU, Med-Surg), behavioral health, compliance, or evidence-based clinical decision support tools.
• Active North Carolina Licensure as a Registered Nurse (RN).
• Must have a valid driver’s license.
• Must reside within North Carolina.
• Must be able to travel within catchment as required.

Preferred:

• Clinical experience in a managed care organization, health plan or hospital setting.

How to Apply

To be considered, submit your application and resume through our ADP Career Center. Your resume must include:

• Employer name, dates of service (month/year), average hours worked per week, and essential job duties
• Education details (degree type, date awarded, institution, field of study)
• Licensure/certification information, if applicable

After submission, your resume will be reviewed to ensure it meets the essential criteria for the position. You’ll be notified by HR regarding your application status as appropriate. All applicants will receive a final update once the recruitment cycle closes.

Join our Talent Community through ADP to stay informed about future opportunities. Be sure to keep your resume updated in your profile.

Trillium Health Resources is an Equal Employment Opportunity (EEO) employer and a drug-free workplace. All candidates must pass a drug test as a condition of employment.

#Innovation #Technology #Careers #NorthCarolina #BehavioralHealth

Attachments (2)

GOVCL004 - UTILIZATION MANAGEMENT NURSE.pdf

Tips for Applying to or Interviewing with Trillium 2.3.26 .pdf