Utilization Management Specialist II

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 disabilities (IDD). Our mission is to help individuals and families build strong foundations for healthy, fulfilling lives.

About the role

The Utilization Management Specialist II supports clinical review by validating service authorization requests and managing workflow from intake through determination. The role reviews requests for completeness, routes cases to appropriate clinical staff, and monitors authorization timelines to ensure timely, accurate clinical review and decision-making.

• Validate service authorization requests against benefit requirements and submission standards prior to clinical review.
• 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 Qualifications

• Experience working with the PH/BH/MH/SU/IDD population.
• Familiarity with and understanding of medical terminology.

Benefits

• 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.

Pay

$56,270 - $69,898

Schedule

Typical working hours: 8:30 am – 5:00 pm; flexible work schedules with some roles with management approval.