Director, Utilization Management – Review

🔥 0 minutes ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $118.3k - $163.9k / year

⏰ Full Time

🔴 Lead

👔 Director

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Trillium Health Resources

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

Trillium Health Resources is a leading specialty care manager (LME/MCO) for individuals with serious behavioral health, intellectual/developmental disabilities, and traumatic brain injury in North Carolina. The organization is committed to investing in the health and well-being of the communities it serves, providing services such as preventive health screenings, crisis intervention, and tailored care management. Trillium focuses on enhancing access to mental health and substance use services for its members and ensuring support for vulnerable populations.

📋 Description

• Lead utilization review functions and ensure operational performance, quality, and compliance of clinical review activities • Direct utilization review operations, mostly post payment reviews, including authorization workflows and clinical review processes • Establish operational priorities and align team activities with organizational goals • Monitor performance metrics, including timeliness, accuracy, and consistency of decisions • Ensure standardized application of clinical criteria, policies, and review guidelines across teams • Oversee development and refinement of workflows, procedures, and review processes • Review paid claims to ensure appropriate code was enacted to be congruent with the paid claim • Drive process improvements to ensure consistent, efficient, and compliant authorization decisions • Travel within catchment as required

🎯 Requirements

• Bachelor's degree in Nursing or health and human services and three (3) years of Utilization Management experience; OR Master's degree in Nursing or health and human services and one (1) year of Utilization Management experience • Active North Carolina licensure as a 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), or Registered Nurse (RN) • Must have a valid driver's license • Must reside within North Carolina • Must be able to travel within catchment as required • All candidates must pass a drug test as a condition of employment • Resume must include employer name, dates of service, average hours worked per week, and essential job duties • Resume must include education details, including degree type, date awarded, institution, and field of study • Resume must include licensure/certification information, if applicable

🏖️ Benefits

• 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 • 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 • 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