Pay Plan Title: NurseManager, Utilization Management
Working Title: Nurse Manager, Utilization Management - Physical Health
Cost Center: 4700/ Utilization Management
FLSA Status: Exempt
Posting Salary Range: $78,624 - $105,158
Office Location: Remote within North Carolina
What We're Looking ForTrillium Health Resources has a career opening for a Nurse Manager, Utilization Management - Physical Health to join our team! The Nurse Manager, Utilization Management - Physical Health leads day-to-day utilization management operations and oversees utilization management teams responsible for authorization and clinical review workflows. The role is accountable for performance monitoring, staff guidance, and manages workflow execution to ensure timely, accurate determinations and consistent application of review standards.
On a typical day, you might:- Lead utilization management teams and oversee daily authorization workflows, including intake, review coordination, and determination processing.
- Manage staff workload to ensure timely completion of authorization activities.
- Monitor turnaround times, decision accuracy, and documentation quality across the team.
- Review cases and decisions to ensure consistent application of clinical criteria and policies.
- Provide clinical guidance and direction to staff on complex or escalated authorization issues.
Resolve provider concerns, complaints, and authorization-related escalations.
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 available for some positions 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) 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
QualificationsRequired:
- Associate's degree in Nursing and three (3) years of experience as an RN in utilization review, utilization management, or prior authorization, to include experience in clinical acute inpatient care (ER, ICU, Med-Surg), post-acute care, health plan operations, and/or behavioral health; OR
- Bachelor's degree in Nursing and one (1) year of experience as an RN in utilization review, utilization management, or prior authorization, to include experience in clinical acute inpatient care (ER, ICU, Med-Surg), post-acute care, health plan operations, and/or behavioral health; OR
- Equivalent combination of education and experience.
- Active North Carolina Licensure as a Registered Nurse (RN).
- Must have a valid driver's license.
- Must reside within North Carolina.
- Must be able to travel within catchment as required.
Preferred:
- Supervisory experience of two (2) or more employees
- Previous working experience with Medicaid
Experience with InterQual guidelines and/or NC Medicaid Clinical Coverage Policies
Deadline for Application: October 12, 2026 at 11:59 PM
How to ApplyTo be considered, submit your application and resume through our ADP Career Center. Your resume must include:
- Employer name, 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 criteria for the position. You'll be notified by HR regarding your application status as appropriate. All applicants will receive a final update once the recruitment cycle closes.
Join our Talent Community through ADP to stay informed about future opportunities. Be sure to keep your resume updated in your profile.
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