Utilization Management Nurse – Physical Health

Pay Plan Title: Utilization Management Nurse
Working Title: Utilization Management Nurse – Physical Health
FLSA Status: Exempt
Posting Salary Range: $68,890 - $92,138
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 Utilization Management Nurse to join our Utilization Management team! The Utilization Management Nurse performs clinical reviews and coordinates care to ensure appropriate use of services and effective care transitions. The role evaluates clinical information, collaborates with providers, and supports discharge planning to improve outcomes and continuity of care.
On a Typical Day, You Might
Conducts prospective, concurrent, and retrospective clinical reviews using established criteria.
Assesses clinical information to determine medical necessity and level of care.
Collaborates with providers and facilities to support treatment planning and discharge coordination.
Performs admission and concurrent reviews to monitor ongoing care needs.
Identifies cases requiring physician review and presents clinical recommendations.
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
Required
Qualifications
Associate's degree in Nursing and 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.
Clinical experience in a managed care organization, health plan, or hospital setting.
Utilization Management certification.
Deadline for Application: Monday, October 5, 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.
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