Utilization Management Specialist III - MH/SU

Trillium Health Resources; North Carolina; Hybrid; USD 69,000 - 92,000; Full time

Benefits offered by this job

Work-from-home options

Health Insurance with no premium for员工

401k with 5% employer match and vest

PSLF qualifying employer

PTO and holidays

Remote work supplies stipend

Job summary

Trillium Health Resources in North Carolina is seeking a Utilization Management Specialist III - MH/SU to join our team. You will perform comprehensive clinical reviews for mental health, substance use, and related conditions, advise on levels of care, and support providers with guidance and documentation.

This remote role offers standard work hours, strong benefits, and the chance to impact lives across our 46 counties.

Qualifications

• Master's degree in health and human services or related field required.
• Active North Carolina licensure as listed (LCSW, LCMHC, LMFT, LPA, LCAS, RN) required.
• Must reside within North Carolina and be able to travel within catchment.

Responsibilities

• Provide clinical review of services for members with mental health, substance use, and/or developmental disabilities including diagnosis review and medical necessity criteria.
• Determine member eligibility and level of care needed and make service authorization decisions with clear documentation.
• Provide clinical triage for members seeking services and offer consultation to providers.
• Provide ongoing review and staffing regarding treatment documentation for group, family, or individual services.

Education

Master's degree in health and human services or related field

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

2 days ago Requisition ID: 3461

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 - MH/SU to join our team! The Utilization Management Specialist III - MH/SU is responsible for providing comprehensive clinical review of services requests for people who experience psychiatric symptoms related to mental health issues and/or co-occurring or co‑morbid conditions or symptoms or addictions to substances and/or developmental disabilities.

On a typical day, you might:

• Provide clinical review of services for members or enrollees with mental health, substance use, and/or developmental disabilities including diagnosis review, medical necessity criteria, determining member eligibility; level of care needed and making service authorization decisions regarding individual service authorizations with timely, clear, concise documentation.
• Provide clinical triage for members seeking services through Screening, Triage and Referral.
• Provide consultation and technical assistance to providers regarding clinical care needs, levels of care, Client Rights Rules, evidenced based practices, scope of practice issues etc.
• Provide ongoing review/staffing/consultation of treatment documentation of needs for members participating in group, family or individual services.

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:

• Master's degree in health and human services or related field and one (1) year of experience
• 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

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

Attachments (2)

Tips for Applying to or Interviewing with Trillium 10.9.26.pdf