Key Facts

Remote From:

Full time

Mid-level (2-5 years)

English

Hard Skills

Clinical Informatics Intensive Care Medicine Utilization Management Discharge Planning Medical Guideline Medical Coding Clinical Documentation Utilization Management Medical Practice Experience Independent Testing +2 more

Other Skills

•
Communication
•
Teamwork
•
Critical Thinking
•
Detail Oriented

Roles & Responsibilities

Fully licensed by the North Carolina State Board of Nursing as an RN
Minimum two years of Utilization Management/Review experience (including clinical acute inpatient care such as ER/ICU/Med-Surg), behavioral health, compliance, or evidence-based clinical decision support tools (e.g., MCG/InterQual)
Valid driver's license
Must reside in North Carolina and be able to travel within catchment as required

Requirements:

Ensure timely and accurate determination and notification of reviews and reconsiderations, and generate approval, modification, and denial communications for members and providers
Facilitate, coordinate, and approve medically necessary reviews that meet established criteria
Perform prospective/preservice, concurrent, post-service, and retrospective medical reviews using clinical judgment and established policies to meet turnaround times
Identify cases needing Medical Director review, present them for potential review or determinations, and collaborate with facilities, physicians, care management, and members to develop discharge plans; maintain records and generate communications within policy timelines

Trillium Health Resources

Insurance

About Trillium Health Resources

Trillium Health Resources manages specialty behavioral health care for eastern North Carolinians across 28 counties. Trillium is committed to transforming lives and building community well-being through partnership, access to services and proven solutions designed to help those we serve reach their fullest potential. Everyone on Trillium’s staff--our care managers, call center, claims agents, project managers, and IT staff--all contribute to this mission. We offer a challenging, engaging work environment where staff take home more than a paycheck. Our performance management plan includes regular check-ins to examine individual employee goals and professional development plan. Our departments work on cross-functional, short-term projects and long ranging initiatives. Every day we see the results of our dedication, in the smiles of children on our accessible playgrounds and pride on the face of an adult cooking a meal for the first time. By joining Trillium, you are doing more than going to work…you are transforming lives. We help those with mental health conditions, intellectual and developmental disabilities, traumatic brain injury, and substance use disorders (Medicaid members and state-funded recipients) get the services they need to improve well-being and live fulfilling lives. We are dedicated to carrying out our mission by investing in the health and well-being of the communities we serve and empowering individuals with access to services, tools and resources to live a fulfilling life. Trillium reserves the right to hide material (comments, images and/or links to other sites) that contains anything vulgar or sexually explicit; is spam; advocates or depicts illegal activity; targets or disparages any ethnic, racial, other type of group; contains personal attacks of any kind; promotes private business ventures, services, or products; campaigns for public office or promotes a political organization; infringes on copyrights or trademarks; or is off topic.

Company type: SME

Industry: Insurance

Founded: 2018

Company size: 501 - 1000

Website LinkedIn See all jobs →

Job description

Pay Plan Title: Registered Nurse

Working Title: Registered Nurse, UM – Physical Health

FLSA Status: Exempt

Posting Salary Range: $66,240 - $88,595

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. We offer our employees:

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.

If you are looking for a unique opportunity to make a tangible impact on the lives of others, apply today!

What We’re Looking For

Trillium Health Resources has a career opening for a Registered Nurse to join our Utilization Management team! The Registered Nurse, UM – Physical Health, is responsible for ensuring timely and accurate determination and notification of reviews and reconsiderations based on the review determination status. The Registered Nurse, UM – Physical Health, will generate approval, modifications, and denials communications, to include member and provider notification of review determination. This position also facilitates, coordinates, and approves medically necessary reviews that meet established criteria.

On a typical day, you might:

Perform prospective/preservice, concurrent, post-service, and retrospective claims medical review processes. Utilizing considerable clinical judgement, independent analysis, critical-thinking skills, and detailed knowledge of clinical coverage policies, clinical practice guidelines, and benefit plans to complete reviews and determinations within required turnaround times specific to the case type. Identify cases needing Medical Director review or input. Present cases to Medical Director for potential review or determinations when needed.
Perform telephonic admission and concurrent review, and collaborate with on-site facility staff, physicians, providers, care management, the member, and significant others to develop and implement a successful discharge plan, if contracted by client.
Maintain accurate records in the designated medical management system and/or claims systems.
Generate appropriate member and provider communication for all determinations within the required timelines as defined by the most current department policy.

Employee Benefits:

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

Typical working hours: 8:30 am – 5:00 pm; 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) https://www.myncretirement.gov/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

Required:

Fully licensed by the North Carolina State Board of Nursing as an RN.
Minimum two (2) years of Utilization Management/Review experience, to include clinical acute inpatient care (ER, ICU, Med-Surg), behavioral health, compliance, or evidence-based clinical decision support tools (ex: MCG/InterQual).
Must have a valid driver’s license.
Must reside within North Carolina.
Must be able to travel within catchment as required.

Preferred:

Clinical experience in a managed care organization, health plan or hospital setting.
Utilization Management certification.

Deadline for Application: Monday, May 18, 2026 at 11:59pm

How to Apply

To be considered, submit your application and resume through our ADP Career Center. Your resume must include:

Employer name, dates of service (month/year), average hours worked per week, and essential job duties
Education details (degree type, date awarded, institution, field of study)
Licensure/certification information, if applicable

After submission, your resume will be reviewed to ensure it meets the essential criteria for the position. You’ll be notified by HR regarding your application status as appropriate. All applicants will receive a final update once the recruitment cycle closes.

Join our Talent Community through ADP to stay informed about future opportunities. Be sure to keep your resume updated in your profile.

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.

#Innovation #Technology #Careers #NorthCarolina #BehavioralHealth

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