Utilization Management Nurse – Physical Health
About the role
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/developmental (IDD) disabilities. Our mission is to help individuals and families build strong foundations for healthy, fulfilling lives. 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, and the chance to make a tangible impact on the lives of others—from children thriving through early intervention and school‑based therapies to adults with severe mental illness living independently and contributing to their communities.
Responsibilities
- 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.
Requirements
- Associate's degree in Nursing.
- Two (2) years of Utilization Management/Review experience, including 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).
- Valid driver’s license.
- Must reside within North Carolina.
- Must be able to travel within the catchment area as required.