Utilization Management Nurse – Physical Health

🔥 22 minutes ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $68.9k - $92.1k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 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

• Conduct prospective, concurrent, and retrospective clinical reviews using established criteria • Assess clinical information to determine medical necessity and level of care • Collaborate with providers and facilities to support treatment planning and discharge coordination • Perform admission and concurrent reviews to monitor ongoing care needs • Identify cases requiring physician review and present clinical recommendations • Coordinate care to ensure appropriate use of services and effective care transitions • Evaluate clinical information and support discharge planning to improve outcomes and continuity of care

🎯 Requirements

• Associate's degree in Nursing • Two (2) years of Utilization Management/Review, to include clinical acute inpatient care (ER, ICU, Med-Surg), behavioral health, compliance, or evidence-based clinical decision support tools • Active North Carolina Licensure as a 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: Physical Health Utilization Management Reviewer experience with a health plan • Preferred: Clinical experience in a managed care organization, health plan, or hospital setting • Preferred: Utilization Management certification • 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, essential job duties, education details, and licensure/certification information

🏖️ 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 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 • 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