Utilization Management Specialist III - IDD

Trillium Health Resources; Boone (NC); Hybrid; USD 69,000 - 92,000; Full time

Benefits offered by this job

Work-from-home options

Health insurance with no premium

Flexible Spending Accounts

PTO + holidays

401k with employer match

Job summary

Trillium Health Resources is seeking an Utilization Management Specialist III – IDD to review service authorization requests and determine appropriate care levels. You will apply medical necessity criteria and provide clinical consultation to ensure quality decisions.

The role requires a Master’s degree in health and human services, NC licensure (LCSW/LCMHC/LMFT/LPA/LCAS/RN), and the ability to travel within North Carolina. Remote work options are available for many positions.

Qualifications

• Master's degree in health and human services or related field and one year of Utilization Management experience.
• Active North Carolina licensure (LCSW, LCMHC, LMFT, LPA, LCAS, RN).
• Valid driver’s license required.
• Must reside in North Carolina and be able to travel within the catchment.

Responsibilities

• Evaluate authorization requests to determine medical necessity and level of care.
• Approve, modify, or deny services based on criteria and guidelines.
• Interpret clinical documentation, diagnoses, and treatment plans.
• Provide clinical consultation to providers and internal teams.
• Perform clinical triage and guide referral decisions.
• Participate in appeals, mediations, hearings, and post-service reviews.

Skills

Active NC licensure

Driver's license

Education

Master's degree in health and human services

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:

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.

What We’re Looking For

Trillium Health Resources has a career opening for a Utilization Management Specialist III – IDD to join our team! The Utilization Management Specialist III performs clinical review of service authorization requests and determines appropriate level of care. The role evaluates clinical information, applies medical

necessity criteria, and provides consultation to ensure appropriate utilization and consistent clinical

decision-making.

On a typical day, you might:

• Evaluate authorization requests to determine medical necessity and appropriate level of care.
• Approve, modify, or make recommendations to deny services based on clinical criteria and established guidelines.
• Interpret clinical documentation, diagnoses, and treatment plans to support determinations.
• Provide clinical consultation to providers and internal teams regarding service requests.
• Perform clinical triage and guide referral decisions based on member needs.
• Participate in appeals, mediations, administrative hearings, and post-service clinical reviews.

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 available for some positions 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:

• Master's degree in health and human services or related field and one (1) year of experience providing Utilization Management services.
• Active North Carolina licensure as:
  • Licensed Clinical Social Worker (LCSW)
  • Licensed Clinical Mental Health Counselor (LCMHC)
  • Licensed Marriage and Family Therapist (LMFT)
  • Licensed Psychological Associate (LPA)
  • Licensed Clinical Addictions Specialist (LCAS)
  • 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:

• Two (2) years of post-Master’s experience in a clinical setting with the IDD/BH/MH/SU population.

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)

Tips for Applying to or Interviewing with Trillium 2.3.26 .pdf