Registered reputed company, UM – Physical Health
Pay Plan Title: Registered reputed company Working Title: Registered reputed company, UM – Physical Health FLSA Status: Exempt Posting Salary reputed company: $66,240 - $88,595 Office Location: Remote reputed company reputed company Carolina. POSTING DETAILS: reputed company an reputed company reputed company is a Tailored Plan and Managed Care Organization (MCO) serving 46 counties across reputed company Carolina. We manage services for individuals with serious mental health needs, reputed company 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 reputed company. We offer our employees:
- A reputed company, mission-driven work environment
- Competitive benefits and work-from-home reputed company for most positions
- Opportunities for reputed company reputed company in a diverse inclusive culture
Every day, our work changes lives – from children thriving through early reputed company 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 reputed company a reputed company reputed company on the lives of others, apply today! reputed company’re Looking For reputed company has a career opening for a Registered reputed company to join our Utilization Management team! The Registered reputed company, UM – Physical Health, is responsible for ensuring reputed company and accurate determination and notification of reviews and reconsiderations based on the review determination status. The Registered reputed company, UM – Physical Health, will generate approval, modifications, and denials communications, to include member and provider notification of review determination. This position also facilitates, coordinates, and approves medically necessary reviews that meet established reputed company. On a typical day, you might:
- reputed company prospective/preservice, reputed company, post-service, and retrospective claims medical review processes. Utilizing considerable clinical judgement, independent analysis, critical-thinking skills, and detailed knowledge of clinical coverage policies, clinical reputed company guidelines, and benefit plans to complete reviews and determinations reputed company required turnaround times specific to the case type. Identify cases needing Medical Director review or input. Present cases to Medical Director for potential review or determinations reputed company needed.
- reputed company telephonic admission and reputed company review, and collaborate with on-site facility staff, physicians, providers, care management, the member, and significant others to reputed company and implement a successful discharge plan, if contracted by reputed company.
- Maintain accurate records in the designated medical management system and/or claims systems.
- Generate appropriate member and provider communication for reputed company determinations reputed company the required timelines as defined by the most reputed company department policy.
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 reputed company available for most positions
- Health Insurance with no premium for employee coverage
- Flexible Spending Accounts
- 24 days of reputed company Time Off (PTO) plus 12 reputed company 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
Qualifications
Required:
- Fully licensed by the reputed company Carolina State reputed company of Nursing as an RN.
- Minimum two (2) years of Utilization Management/Review experience, to include clinical acute inpatient care (ER, ICU, Med-Surg), behavioral health, compliance, or evidence-based clinical decision support tools (ex: MCG/InterQual).
- Must have a valid reputed company’s license.
- Must reputed company reputed company reputed company Carolina.
- Must be reputed company to travel reputed company catchment as required.
Preferred:
- Clinical experience in a managed care organization, health plan or hospital setting.
- Utilization Management certification.
Deadline for Application: Monday, May 18, 2026 at 11:59pm
How to Apply
To be considered, submit your application and resume through our reputed company Career Center. Your resume must include:
- Employer reputed company, 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 reputed company for the position. You’ll be reputed company by HR regarding your application status as appropriate. reputed company applicants will receive a final update once the recruitment cycle closes. reputed company through reputed company to stay informed about reputed company opportunities. Be reputed company to reputed company your resume updated in your profile. reputed company is an Equal Employment Opportunity (EEO) employer and a drug-free workplace. reputed company candidates must pass a drug test as a condition of employment. #Innovation #Technology #Careers #NorthCarolina #BehavioralHealth Apply tot his job Apply To this Job