Utilization Management Nurse – Physical Health

Trillium Health Resources; United States; Remote; USD 69,000 - 92,000; Full time

Benefits offered by this job

Health Insurance

Remote work options

401k with employer match

PTO & holidays

PSLF eligibility

Remote work stipend

Job summary

Trillium Health Resources is seeking a Registered Nurse to join our Utilization Management team in North Carolina. The UM reviews, coordinates care, and supports discharge planning to improve outcomes and ensure appropriate utilization of services.

The position offers remote work from NC, standard hours 8:30am–5:00pm, and competitive benefits including health insurance, 401k match, PTO, and PSLF eligibility. Travel within the catchment may be required.

Qualifications

• Associate's degree in Nursing required.
• Active North Carolina RN licensure.
• Valid driver's license; ability to travel within catchment.

Responsibilities

• Performs clinical reviews (prospective, concurrent, retrospective) using established criteria.
• Assesses medical necessity and level of care.
• Collaborates with providers and facilities for discharge planning.
• Identifies cases requiring physician review and presents recommendations.
• Supports care transitions to improve outcomes.

Skills

RN licensure

Education

Associate's degree in Nursing

RN licensure in NC

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

9 days ago Requisition ID: 3436

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:

• Physical Health Utilization Management Reviewer experience with a health plan.
• Clinical experience in a managed care organization, health plan, or hospital setting.

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.

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Attachments (2)

Tips for Applying to or Interviewing with Trillium 2.3.26 .pdf