Utilization Management Nurse – Physical Health

NEPSE Trading; Northern (KY); Hybrid; USD 69,000 - 92,000; Full time

Benefits offered by this job

Health Insurance

Flexible Spending Accounts

Paid Time Off

Public Service Loan Forgiveness (PSLF)

401k with employer match

Job summary

Trillium Health Resources is seeking a Utilization Management Nurse – Physical Health to perform clinical reviews and coordinate care for members across North Carolina. This exempt, remote role supports discharge planning and ensures appropriate service use in a managed care setting.

The successful candidate holds an Associate's degree in Nursing with an active NC RN license and at least two years in UM/Review, including acute inpatient and behavioral health contexts.

Qualifications

• Associate degree in Nursing required.
• Active NC RN licensure required.
• Two years of Utilization Management/Review experience required, covering acute inpatient care (ER/ICU/Med-Surg), behavioral health, or evidence-based decision support.

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.
• Identify cases requiring physician review and present clinical recommendations.

Skills

Utilization Management

Clinical reviews

Travel flexibility

Education

Associate's degree in Nursing

Active North Carolina RN Licensure

Job description

# Utilization Management Nurse – Physical HealthTrillium Health ResourcesUnited StatesFull timeRemoteUSD 68,890 – 92,138Apply by Dec 5, 2026## About the rolePay Plan Title: Utilization Management Nurse Working Title: Utilization Management Nurse – Physical Health 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: A collaborative, mission-driven work environment Competitive### benefitsand 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 NC Local Government Retirement Pension (defined-benefit plan) 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: Physical Health Utilization Management Reviewer experience with a health plan.Clinical experience in a managed care organization, health plan, or hospital setting. Utilization Management certification. Deadline for Application: Monday, October 5, 2026 at 11:59pm