Utilization Management Specialist III - MH/SU

Trillium Health Resources; Raleigh (NC); Remote; USD 69,000 - 92,000; Full time

Benefits offered by this job

Work-from-home options

Health Insurance

Paid Time Off

401k with employer match

Remote work stipend

Job summary

Trillium Health Resources is seeking an Utilization Management Specialist III - MH/SU to perform comprehensive clinical review of service requests for individuals with mental health, substance use, or related conditions. The role emphasizes timely decisions, documentation, and provider consultation.

The position requires a Master’s degree in a relevant field and active North Carolina licensure; travel within the NC catchment is expected. Remote work options are available for many roles.

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).
• 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, level of care, and make service authorization decisions with clear documentation.
• Provide clinical triage for members seeking services and offer consultation to providers on care needs and scope of practice.
• Review and staff treatment documentation for group, family, or individual services.

Education

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

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)

Job description

Pay Plan Title: Utilization Management Specialist III

Working Title: Utilization Management Specialist III

MH/SUFLSA 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.

• 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 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.

Typical working hours:

8:30 am – 5:00 pm; flexible work schedules with some roles with management approval.

Employee Benefits

Trillium knows that work/life balance is essential. That’s why we offer:

• 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) systems-funds/local-governmental-employees-retirement-system-lgers/lgers-handbook
• 401k with 5% employer match and immediate vesting
• Public Service Loan Forgiveness (PSLF) qualifying employer
• Quarterly stipend for remote work supplies

Qualifications

• Master's degree in health and human services or related field and one (1) year of experienceproviding 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: A minimum of two (2) years of post-Master’s experience in a clinical setting with the BH/MH/SU/IDD population.

Deadline for Application:

Wednesday, October 21, 2026 at 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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