Director, Utilization Management – Review
TRILLIUM HEALTH RESOURCES•Remote in North Carolina, NC, US, NC
•$118,292 - $163,939•Remote
About The Position
Trillium Health Resources is seeking a Director, Utilization Management to lead utilization review functions. This role is accountable for the operational performance, quality, and compliance of clinical review activities. The Director will set operational priorities, oversee workflows and performance, and drive process improvements to ensure consistent, efficient, and compliant authorization decisions. The position focuses on post-payment reviews and ensuring appropriate coding for paid claims.
Requirements
- Bachelor's degree in Nursing or health and human services and three (3) years of Utilization Management experience; OR Master's degree in Nursing or health and human services and one (1) year of Utilization Management experience.
- 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), or Registered Nurse (RN).
- Must have a valid driver’s license.
- Must reside within North Carolina.
- Must be able to travel within catchment as required.
Responsibilities
- Direct utilization review operations, mostly post payment reviews, including authorization workflows and clinical review processes.
- Establish operational priorities and align team activities with organizational goals.
- Monitor performance metrics, including timeliness, accuracy, and consistency of decisions.
- Ensure standardized application of clinical criteria, policies, and review guidelines across teams.
- Oversee development and refinement of workflows, procedures, and review processes.
- Review paid claims to ensure appropriate code was enacted to be congruent with the paid claim.
Benefits
- 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
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What This Job Offers
Job Type
Full-time
Career Level
Director
