Pay Plan Title:Utilization Management Specialist III
Working Title:Utilization Management Specialist III - MH/SU
FLSA Status:Exempt
Posting Salary Range:$68,890- $92,138
Office Location:Remote within North Carolina
POSTING DETAILS:
Make an Impact
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.
Why Work for Us?
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
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.
If you are looking for a unique opportunity to make a tangible impact on the lives of others, apply today!
What We’re Looking For
Trillium Health Resources has a career opening for a Utilization Management Specialist III - MH/SU to join our team! The Utilization Management Specialist III - MH/SU is responsible for providing comprehensive clinical review of services requests for people who experience psychiatric symptoms related to mental health issues and/or co-occurring or co-morbid conditions or symptoms or addictions to substances and/or developmental disabilities.
On a typical day, you might:
- Provide clinical review of services for members or enrollees with mental health, substance use, and/or developmental disabilities including diagnosis review, medical necessity criteria, determining member eligibility; level of care needed and making service authorization decisions regarding individual service authorizations with timely, clear, concise documentation.
- Provide clinical triage for members seeking services through Screening, Triage and Referral.
- Provide consultation and technical assistance to providers regarding clinical care needs, levels of care, Client Rights Rules, evidenced based practices, scope of practice issues etc.
- Provide ongoing review/staffing/consultation of treatment documentation of needs for members participating in group, family or individual services.
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 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
Qualifications
Required:
- Master's degree in health and human services or related field and one (1) year of experience
providing Utiliz
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