Utilization Management (UM) Coordinator

TRILLIUM HEALTH RESOURCES

7d•Remote

About The Position

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 Health Resources has a career opening for a Utilization Management (UM) Coordinator to join our team! The UM Coordinator is responsible for managing the administrative components of the clinical review process for service authorization requests related to Intellectual/Developmental Disabilities (IDD), Behavioral Health (BH)/Mental Health (MH), and Substance Use (SU) services. This position is responsible for pre-screening requests to determine completeness and compliance with the Trillium Benefit Plan and Clinical Coverage Policies, ensuring they are ready for clinical review. Working collaboratively with Utilization Management (UM) Clinicians, this position oversees documentation accuracy, tracks review timelines and outcomes, communicates decisions to providers, and ensures required notifications are issued appropriately.

Requirements

High School Diploma/GED and six (6) years’ experience working in the BH/MH/SU/IDD field; OR
Associate’s degree and four (4) years’ experience working in the BH/MH/SU/IDD field; OR
Bachelor’s degree and two (2) years’ experience working in the BH/MH/SU/IDD field; OR
Equivalent combination of education/experience.
Must have a valid driver’s license.
Must reside within North Carolina.

Nice To Haves

Experience working with the BH/MH/SU/IDD population.

Responsibilities

Review and pre-screen IDD/MHSU service authorization requests.
Manage and monitor the timeliness of clinical reviews.
Coordinate and oversee the submission of clinical documentation.
Track Peer Reviewer decisions and independently communicate outcomes to clinicians.
Ensure all required notices and actions are issued appropriately and on time.

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

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