Director, Utilization Management – Review

Trillium Health Resources

. Lead utilization review functions and ensure operational performance, quality, and compliance of clinical review activities .

Posted 9/22/2026full-timeRemote • North Carolina • United StatesLead💰 $118,292 - $163,939 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in Utilization Management, ensuring compliance and quality in clinical review processes while driving operational performance and process improvements. Holds relevant licensure and a strong educational background in Nursing or health and human services.

Highest-signal resume keywords

Utilization Management ExperienceClinical Review ProcessesNorth Carolina LicensureOperational Performance MonitoringProcess Improvement

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Utilization ReviewClinical Criteria ApplicationAuthorization WorkflowsPerformance Metrics MonitoringWorkflow DevelopmentClaims ReviewCompliance StandardsDecision ConsistencyQuality Assurance

Soft Skills

LeadershipTeam AlignmentCommunication

Certifications & Qualifications

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)

Industry Keywords

Health and Human ServicesClinical Review ActivitiesPost Payment ReviewsAuthorization DecisionsDrug Test Compliance

About the role

Key responsibilities & impact

Lead utilization review functions and ensure operational performance, quality, and compliance of clinical review activities
Direct utilization review operations, mostly post payment reviews, including authorization workflows and clinical review processes
Establish operational priorities and align team activities with organizational goals
Monitor performance metrics, including timeliness, accuracy, and consistency of decisions
Ensure standardized application of clinical criteria, policies, and review guidelines across teams
Oversee development and refinement of workflows, procedures, and review processes
Review paid claims to ensure appropriate code was enacted to be congruent with the paid claim
Drive process improvements to ensure consistent, efficient, and compliant authorization decisions
Travel within catchment as required

Requirements

What you’ll need

Bachelor's degree in Nursing or health and human services and three (3) years of Utilization Management experience; OR Master's degree in Nursing or health and human services and one (1) year of Utilization Management experience
Active North Carolina licensure as a 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), or Registered Nurse (RN)
Must have a valid driver's license
Must reside within North Carolina
Must be able to travel within catchment as required
All candidates must pass a drug test as a condition of employment
Resume must include employer name, dates of service, average hours worked per week, and essential job duties
Resume must include education details, including degree type, date awarded, institution, and field of study
Resume must include licensure/certification information, if applicable

Benefits

Comp & perks

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 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)
401k with 5% employer match and immediate vesting
Public Service Loan Forgiveness (PSLF) qualifying employer
Quarterly stipend for remote work supplies