Utilization Management Specialist II

Socket.dev; North Carolina; Hybrid; USD 56,000 - 70,000; Full time

Benefits offered by this job

Health insurance (employee)

Work-from-home options

Paid time off + holidays

NC retirement pension

401k with employer match

PSLF eligible employer

Remote work stipend

Job summary

Trillium Health Resources is seeking an Utilization Management Specialist II to validate service authorizations and manage workflow from intake through determination. The role ensures completeness, routes cases to clinical staff, and monitors timelines to support timely decision-making.

Qualifications include relevant MH/SU/IDD experience, a valid NC driver’s license, and NC residency with travel as required.

Qualifications

• Requires MH/SU/IDD experience at various education levels (HS, associate, bachelor)
• Must have a valid driver’s license
• Residency within North Carolina and ability to travel within catchment

Responsibilities

• Validate service authorization requests against benefit requirements prior to clinical review.
• Identify missing or inconsistent documentation and obtain required information from providers.
• Route complete requests to appropriate clinical reviewers based on service type and urgency.
• Monitor authorization timeframes and follow up to prevent delays in clinical review.
• Track determinations and ensure authorization status is accurately reflected in systems.

Skills

MH/SU/IDD experience

Driver's license

Education

High School Diploma/GED

Associate's degree

Bachelor's degree

Equivalent education/experience

Job description

Pay Plan Title: Utilization Management Specialist II

Working Title: Utilization Management Specialist II

Position Number: 04004

FLSA Status: Exempt

Posting Salary Range: $56,270 - $69,898

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 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.

What We’re Looking For

Trillium Health Resources has a career opening for a Utilization Management Specialist II to join our team! The Utilization Management Specialist II supports clinical review by validating service authorization requests and managing workflow from intake through determination. The role reviews requests for completeness, routes cases to appropriate clinical staff, and monitors authorization timelines to ensure timely, accurate clinical review and decision-making.

On a typical day, you might:

• Validate service authorization requests against benefit requirements and submission standards prior to clinical review or for post payment reviews.
• Identify missing or inconsistent documentation and obtain required information from providers.
• Route complete requests to appropriate clinical reviewers based on service type and urgency.
• Monitor authorization timeframes and follow up to prevent delays in clinical review.
• Track determinations and ensure authorization status is accurately reflected in systems.

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:

• High School Diploma/GED and six (6) years’ experience working in the MH/SU/IDD field; OR
• Associate’s degree and four (4) years’ experience working in the MH/SU/IDD field;OR
• Bachelor’s degree and two (2) years’ experience working in the MH/SU/IDD field; OR
• Equivalent combination of education/experience.
• Must have a valid driver’s license.
• Must reside within North Carolina.
• Must be able to travel within catchment as required.

Preferred:

• Experience working with the PH/BH/MH/SU/IDD population.
• Familiarity with and understanding of medical terminology.

Deadline for Application:Friday, October 2, 2026 @ 11:59PM

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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