Registered Nurse, UM – Physical Health, NC

2967 Pay Plan Title: Registered Nurse Working Title: Registered Nurse, UM – Physical Health FLSA Status: Exempt Posting Salary Range: $66,240 - $88,595 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 Registered Nurse to join our Utilization Management team! The Registered Nurse, UM – Physical Health, is responsible for ensuring timely and accurate determination and notification of reviews and reconsiderations based on the review determination status. The Registered Nurse, UM – Physical Health, will generate approval, modifications, and denials communications, to include member and provider notification of review determination. This position also facilitates, coordinates, and approves medically necessary reviews that meet established criteria. On a typical day, you might:

• Perform prospective/preservice, concurrent, post-service, and retrospective claims medical review processes. Utilizing considerable clinical judgement, independent analysis, critical-thinking skills, and detailed knowledge of clinical coverage policies, clinical practice guidelines, and benefit plans to complete reviews and determinations within required turnaround times specific to the case type. Identify cases needing Medical Director review or input. Present cases to Medical Director for potential review or determinations when needed.
• Perform telephonic admission and concurrent review, and collaborate with on-site facility staff, physicians, providers, care management, the member, and significant others to develop and implement a successful discharge plan, if contracted by client.
• Maintain accurate records in the designated medical management system and/or claims systems.
• Generate appropriate member and provider communication for all determinations within the required timelines as defined by the most current department policy.

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 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) 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:

• Fully licensed by the North Carolina State Board of Nursing as an RN.
• Minimum one (1) year of clinical nursing experience.
• Must have a valid driver’s license.
• Must reside within North Carolina.
• Must be able to travel within catchment as required.

Preferred:

• Bachelor’s degree in nursing.
• One (1) to two (2) years of experience in utilization management or managed care setting.
• Utilization Management certification.

Deadline for Application: Monday, February 2, 2026

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 Apply tot his job Apply To this Job