Utilization Management Specialist II

Trillium Health Resources

. Support clinical review by validating service authorization requests and managing workflow from intake through determination .

Posted 9/23/2026full-timeRemote • North Carolina • United StatesJuniorMid-Level💰 $56,270 - $69,898 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in validating service authorization requests and managing clinical review workflows, with a strong understanding of medical terminology and experience in the MH/SU/IDD field. Capable of tracking determinations and ensuring accurate authorization status in systems while maintaining compliance with submission standards.

Highest-signal resume keywords

Experience In MH/SU/IDD FieldValid Driver's LicenseKnowledge Of Medical TerminologyAuthorization Workflow ManagementDocumentation Validation

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Service Authorization ValidationClinical Review SupportDocumentation ManagementWorkflow ManagementTracking Determinations

Soft Skills

Attention To DetailCommunication SkillsProblem-Solving Skills

Industry Keywords

MH/SU/IDDClinical ReviewAuthorization RequestsBenefit RequirementsPost-Payment Reviews

About the role

Key responsibilities & impact

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 or for post-payment reviews
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

What you’ll need

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
Preferred: Experience working with the PH/BH/MH/SU/IDD population
Preferred: Familiarity with and understanding of medical terminology
All candidates must pass a drug test as a condition of employment

Benefits

Comp & perks

Collaborative, mission-driven work environment
Competitive benefits
Work-from-home options for most positions
Flexible work schedules for some roles with management approval
Health insurance with no premium for employee coverage
Flexible Spending Accounts
24 days of Paid Time Off (PTO) plus 12 paid holidays in the 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