Nurse Manager, Utilization Management – Physical Health

🔥 2 minutes ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $78.6k - $105.2k / year

⏰ Full Time

🟢 Junior

👔 Manager

👻 Ghost score 0%

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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 management teams and oversee daily authorization workflows, including intake, review coordination, and determination processing • Manage staff workload to ensure timely completion of authorization activities • Monitor turnaround times, decision accuracy, and documentation quality across the team • Review cases and decisions to ensure consistent application of clinical criteria and policies • Provide clinical guidance and direction to staff on complex or escalated authorization issues • Resolve provider concerns, complaints, and authorization-related escalations • Oversee utilization management operations and authorization and clinical review workflows • Monitor performance and guide staff to ensure timely, accurate determinations and consistent review standards • Travel within the catchment as required

🎯 Requirements

• Associate's degree in Nursing and three (3) years of experience as an RN in utilization review, utilization management, or prior authorization, to include experience in clinical acute inpatient care (ER, ICU, Med-Surg), post-acute care, health plan operations, and/or behavioral health; OR Bachelor's degree in Nursing and one (1) year of experience as an RN in utilization review, utilization management, or prior authorization, to include experience in clinical acute inpatient care (ER, ICU, Med-Surg), post-acute care, health plan operations, and/or behavioral health; OR equivalent combination of education and experience • Active North Carolina Licensure as a Registered Nurse (RN) • Valid driver's license • Must reside within North Carolina • Must be able to travel within catchment as required • Must pass a drug test as a condition of employment • Supervisory experience of two (2) or more employees (preferred) • Previous working experience with Medicaid (preferred) • Experience with InterQual guidelines and/or NC Medicaid Clinical Coverage Policies (preferred) • Resume must include employer name, dates of service, average hours worked per week, essential job duties, education details, and licensure/certification information if applicable

🏖️ Benefits

• Collaborative, mission-driven work environment • Competitive benefits • Work-from-home options for most positions • Flexible work schedules available for some positions with management approval • 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