Utilization Management Specialist II

🔥 19 hours ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $56.3k - $69.9k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

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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

• Support clinical review by validating service authorization requests and managing workflow from intake through determination • Validate service authorization requests against benefit requirements and submission standards prior to clinical review or for post-payment reviews • Identify missing or inconsistent documentation and obtain required information from providers • Route complete requests to appropriate clinical reviewers based on service type and urgency • Monitor authorization timeframes and follow up to prevent delays in clinical review • Track determinations and ensure authorization status is accurately reflected in systems

🎯 Requirements

• High School Diploma/GED and six (6) years’ experience working in the MH/SU/IDD field; OR Associate’s degree and four (4) years’ experience working in the MH/SU/IDD field; OR Bachelor’s degree and two (2) years’ experience working in the MH/SU/IDD field; OR equivalent combination of education/experience • Must have a valid driver’s license • Must reside within North Carolina • Must be able to travel within catchment as required • Preferred: Experience working with the PH/BH/MH/SU/IDD population • Preferred: Familiarity with and understanding of medical terminology • All candidates must pass a drug test as a condition of employment

🏖️ Benefits

• Collaborative, mission-driven work environment • Competitive benefits • Work-from-home options for most positions • Flexible work schedules for some roles 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 the 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