Utilization Management Specialist III - IDD

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Full Time Professionals
* Trillium office based location as specified below: US 2 Attachments

Salary Range: $68,890.00 To $92,138.00 Annually

FLSA Status:Exempt

Posting Salary Range:$68,890-$92,138

Office

Location:

Remote within North Carolina

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.

Trillium believes that empowering others begins with supporting our team. We offer our employees:

• 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.

Trillium Health Resources has a career opening for a Utilization Management Specialist III – IDD to join our team! The Utilization Management Specialist III performs clinical review of service authorization requests and determines appropriate level of care. The role evaluates clinical information, applies medical

necessity criteria, and provides consultation to ensure appropriate utilization and consistent clinical

decision-making.

• Evaluate authorization requests to determine medical necessity and appropriate level of care.
• Approve, modify, or make recommendations to deny services based on clinical criteria and established guidelines.
• Interpret clinical documentation, diagnoses, and treatment plans to support determinations.
• Provide clinical consultation to providers and internal teams regarding service requests.
• Perform clinical triage and guide referral decisions based on member needs.
• Participate in appeals, mediations, administrative hearings, and post-service clinical reviews.

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

• Master's degree in health and human services or related field and one (1) year of experience providing Utilization Management services.
• Active North Carolina licensure as:
  • Licensed Clinical Social Worker (LCSW)
  • Licensed Clinical Mental Health Counselor (LCMHC)
  • Licensed Marriage and Family Therapist (LMFT)
  • Licensed Psychological Associate (LPA)
  • Licensed Clinical Addictions Specialist (LCAS)
  • Registered Nurse (RN)
• Must have a valid driver’s license.
• Must reside within North Carolina.
• Must be able to travel within catchment as required.

• Two (2) years of post-Master’s experience in a clinical setting with the IDD/BH/MH/SU population.

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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Tips for Applying to or Interviewing with Trillium 2.3.26 .pdf