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

PTO & holidays

401k with employer match

PSLF qualifying employer

Remote work options

Remote work stipend

Job summary

Trillium Health Resources is seeking a Utilization Management Nurse to join our Utilization Management team. The role conducts clinical reviews, coordinates care, and supports discharge planning to improve outcomes.

This exempt, full-time position offers remote work within North Carolina, competitive benefits, and opportunities to collaborate with providers across our 46 counties.

Qualifications

• Associate's degree in Nursing and 2 years in Utilization Management/Review including acute inpatient care (ER, ICU, Med-Surg) and behavioral health.
• Active North Carolina RN licensure.
• Valid driver’s license.
• Must reside in North Carolina and be able to travel within catchment.

Responsibilities

• Conduct prospective, concurrent, and retrospective clinical reviews using established criteria.
• Assess clinical information to determine medical necessity and level of care.
• Collaborate with providers and facilities to support treatment planning and discharge coordination.
• Perform admission and concurrent reviews to monitor ongoing care needs and present clinical recommendations.

Skills

Utilization Management

Clinical reviews

Discharge planning

Provider collaboration

Remote work capability

Education

Associate's degree in Nursing

RN Licensure in North Carolina

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

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:

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.

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.

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.
• Assess 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.

Attachments (2)

GOVCL004 - UTILIZATION MANAGEMENT NURSE.pdf

Tips for Applying to or Interviewing with Trillium 2.3.26 .pdf