Utilization Management Specialist II
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Job Description
Utilization Management Specialist validating behavioral-health service authorizations for Trillium Health Resources. Routing clinical reviews and monitoring determinations across North Carolina.
Responsibilities:
- Support clinical review by validating service authorization requests and managing workflow from intake through determination
- Validate service authorization requests against benefit requirements and submission standards prior to clinical review
- Identify missing or inconsistent documentation and obtain required information from providers
- Route complete requests to appropriate clinical reviewers based on service type and urgency
- Monitor authorization timeframes and follow up to prevent delays in clinical review
- Track determinations and ensure authorization status is accurately reflected in systems
Requirements:
- High School Diploma/GED and six (6) years’ experience working in the MH/SU/IDD field; OR Associate’s degree and four (4) years’ experience working in the MH/SU/IDD field; OR Bachelor’s degree and two (2) years’ experience working in the MH/SU/IDD field; OR Equivalent combination of education/experience
- Must have a valid driver’s license
- Must reside within North Carolina
- Must be able to travel within catchment as required
- Experience working with the PH/BH/MH/SU/IDD population preferred
- Familiarity with and understanding of medical terminology preferred
- All candidates must pass a drug test as a condition of employment
- Resume must include employer name, dates of service (month/year), average hours worked per week, essential job duties, education details, and licensure/certification information if applicable
Benefits:
- 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
- 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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