Utilization Management Specialist III - IDD

Salary Range: $68,890.00 To $92,138.00 Annually Pay Plan Title: Utilization Management Specialist III Working Title: Utilization Management Specialist III - IDD Cost Center: 4700/Utilization Management 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 – IDD to join our team! The Utilization Management Specialist III performs clinical review of service authorization requests and determines appropriate level of care. The role evaluates clinical information, applies medical necessity criteria, and provides consultation to ensure appropriate utilization and consistent clinical decision-making. On a typical day, you might: Evaluate authorization requests to determine medical necessity and appropriate level of care. Approve, modify, or make recommendations to deny services based on clinical criteria and established guidelines. Interpret clinical documentation, diagnoses, and treatment plans to support determinations. Provide clinical consultation to providers and internal teams regarding service requests. Perform clinical triage and guide referral decisions based on member needs. Participate in appeals, mediations, administrative hearings, and post-service clinical reviews. 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 Qualifications Required: Master's degree in health and human services or related field and one (1) year of experience providing Utilization Management services. 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) 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: Two (2) years of post-Master’s experience in a clinical setting with the IDD/BH/MH/SU population. Deadline for Application: September 17, 2026 at 11:59 PM How to Apply To 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. Trillium Health Resources is an Equal Employment Opportunity (EEO) employer and a drug-free workplace. All candidates must pass a drug test as a condition of employment. #Innovation #Technology #Careers #NorthCarolina #BehavioralHealth Attachments (2) GOVCL003 - Utilization Management Specialist III.pdf Tips for Applying to or Interviewing with Trillium 2.3.26 .pdf