[Hiring] Utilization Management Nurse @TRILLIUM HEALTH RESOURCES

Role Description

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:

• Conduct prospective, concurrent, and retrospective clinical reviews using established criteria.
• Assess clinical information to determine medical necessity and level of care.
• Collaborate with providers and facilities to support treatment planning and discharge coordination.
• Perform admission and concurrent reviews to monitor ongoing care needs.
• Identify cases requiring physician review and present clinical recommendations.

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.

Requirements

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

Benefits

• 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).
• 401k with 5% employer match and immediate vesting.
• Public Service Loan Forgiveness (PSLF) qualifying employer.
• Quarterly stipend for remote work supplies.