Jobs at Trillium Health Resources

Coordinate and schedule application releases across environments, track components and dependencies, maintain release documentation, develop database objects and reporting, support data integration and database administration to ensure stable, secure deployments.

Perform data analysis and reporting to meet DMH/DMA contract, NCQA, and HEDIS requirements; develop user-friendly reports, analyze population and pharmacy/physical health data, support quality improvement and accreditation activities, and assist QM department operations and committees.

Serve as the primary contact between providers and Trillium, handling inquiries about claims, grievances, onboarding, and data updates. Provide timely, service-oriented responses, prepare documents and reports, track outcomes, and maintain provider relationships.

Process and approve enrollment requests and member updates, verify Medicaid and third-party insurance eligibility, monitor coverage changes, correct member data in Trillium's software, and educate staff on insurance types to ensure accurate service delivery.

Provide clinical support for provider network operations, evaluate provider performance, address access gaps, collaborate with cross-functional teams, and support continuous improvement to enhance quality and member access within an MCO.

Provide pre-release and post-release care coordination for justice-involved adults with behavioral health or IDD conditions. Educate members/guardians, connect to community resources (housing, benefits, employment, transportation), build relationships with correctional and probation systems, and facilitate warm handoffs to ongoing care management using person-centered planning.

Supervise the Registry of Unmet Needs (RUN) team and coordinate Tailored Care Management for members. Manage hiring, training, evaluation, staff productivity, compliance with URAC/NCQA/Medicaid/DMH/DD/SAS, and use data to monitor performance and refine processes. Collaborate internally and with external partners and support managed care operations.

Provide peer-based outreach, education, and support to individuals with serious mental illness or substance use needs in institutional and community settings. Facilitate diversion and transition planning for permanent supportive housing, coordinate care with clinical and rehousing teams, link members to services, and use person-centered methods to support community integration and rights education.

Serve as Trillium's primary contact to the Lumbee and state Tribes, coordinating meetings, advising on policy and culturally responsive practices, resolving tribal member issues, integrating cultural humility training, analyzing health disparities, and collaborating with tribal and internal partners to improve services for American Indian communities.

Manage and coordinate provider and member claim issues via phone, email, and ticketing. Research claims in processing systems, track and respond to tickets, draft provider communications, identify trends, and recommend system or training updates. Support escalations and State Department inquiries to ensure timely, accurate resolutions.

Coordinate Competitive Integrated Employment referrals and supports for individuals with IDD and MH/DD/SA needs. Review employment assessments and career plans, ensure provider compliance with state reporting and documentation, collect proof of employment, conduct outreach, and assist members and families in accessing employment-related services and supports.

Manage and monitor provider network quality and compliance for behavioral health services. Conduct objective audits, oversee corrective action/Plans of Correction, provide technical assistance to providers, ensure adherence to federal, state, and accreditation standards, and maintain inter-rater reliability in reviews.

Design, develop, and refine online and blended training content; administer and support the My Learning Campus LMS (course creation, integrations, reporting, user support); analyze learning data to improve content and system performance; coordinate vendors and internal teams; create instructional graphics and digital learning assets; ensure usability, accessibility, and data integrity.

Support fiscal management, monitoring, and coordination for SOC collaborative projects. Track/process expenditures, ensure DHHS/SAMHSA NOA compliance, navigate procurement systems, purchase project items, prepare financial reports, and serve as liaison between agencies and internal teams to support project implementation.

Provide care coordination and transition/discharge planning for individuals in the Transitions to Community Living Initiative, assess needs, develop care plans, monitor progress, collaborate with clinicians and community supports, complete assessments, and document activities in state and organizational electronic systems.

Audit and analyze pre- and post-payment claim adjudication for NC Medicaid/CMS compliance, review claim documentation, identify errors, resolve rejections, provide provider training and technical assistance, and communicate with stakeholders to ensure accurate claims processing.

The IDD Monitoring Coordinator ensures compliance with HCBS requirements, monitors services for individuals with intellectual disabilities, and conducts assessments and communication to promote service satisfaction.

Lead and oversee healthcare claims processing, ensure accurate payments and reporting, research and correct claim issues, manage appeals and provider inquiries, develop procedures, and train/mentor claims staff.

Design, develop, and support the Data Warehouse and reporting systems. Build and optimize SSRS reports, Power BI dashboards, and SQL ETL/queries. Ensure data accuracy, maintain documentation, and mentor team members while collaborating with business units to translate requirements into scalable data solutions.