Jobs at Trillium Health Resources

Supports utilization management by validating service authorization requests, identifying missing documentation, routing complete cases to clinical reviewers, monitoring authorization timelines, and tracking determinations in systems. The role serves managed-care populations involving mental health, substance use, traumatic brain injury, and intellectual or developmental disabilities. It is remote within North Carolina but requires a valid driver’s license, state residency, and travel within the service area as needed.

Directs utilization management and post-payment clinical review operations for a managed care organization. Oversees authorization workflows, performance metrics, clinical criteria application, compliance, process improvements, and claims coding accuracy. The role requires a relevant bachelor's or master's degree, utilization management experience, an active North Carolina clinical license, North Carolina residency, a valid driver's license, and travel within the service area.

Develops, maintains, administers, and governs enterprise business applications and automation solutions. Designs scalable solutions using Power Apps, Power Pages, Power Automate, and Dataverse; administers Power Platform environments; creates data architectures and workflows; resolves application issues; and supports governance, security, compliance, and software development lifecycle activities.

Leads complex informatics and technology projects, including data analysis, dashboard and report development, data quality validation, requirements gathering, business process documentation, Agile delivery, and coordination between business and technical stakeholders.

Connects individuals with housing, food, transportation, employment, and other community resources. Receives referrals, assesses resource needs, coordinates connections with community organizations and public programs, follows up on referrals, identifies unresolved needs, and accurately documents activities and outcomes. Requires regional travel and collaboration with behavioral health, substance use, and intellectual/developmental disability populations.

Oversee complex enterprise-wide IT projects and multi-project programs, ensuring alignment with business needs, governance, risk management, portfolio outcomes, and executive reporting. Develop integrated plans, roadmaps, budgets, timelines, and dependency management processes. Lead and supervise project managers and analysts, including coaching, performance evaluations, hiring, and onboarding. Collaborate across administrative, clinical, HR, IT, and quality functions in a regulated healthcare environment.

Oversees provider service operations across multiple teams, leading managers, monitoring performance and quality metrics, identifying operational risks, and implementing improvement initiatives. Develops provider relations strategies, policies, procedures, and workflows while collaborating with providers and internal stakeholders to resolve issues and ensure compliant, efficient, high-quality service delivery.

Leads enterprise Power Platform application delivery, governance, architecture, lifecycle management, security, environment strategy, and support practices. Manages solution development using Power Apps, Power Automate, Dataverse, and Power Pages; oversees staff and scalable integrations with enterprise systems. Partners with stakeholders on automation, modernization, workflow improvement, and digital transformation while ensuring compliance, maintainability, and effective Agile execution.

Provides departmental administrative support by preparing correspondence, reports, and presentations; coordinating meetings, trainings, and events; tracking deadlines, deliverables, and metrics; maintaining data accuracy; supporting audits and workflows; and assisting with departmental projects and communications.

Manages the applications product backlog, prioritizes user stories, and leads Product Services and Project Services teams. Drives application development and delivery using Agile Scrum, facilitates Scrum ceremonies, evaluates team performance, and contributes to business systems architecture, design, configuration, and program specifications. The role also supports healthcare-related applications and requires a valid driver's license, U.S. residency, and travel within the service area as needed.

Provides peer support and transition assistance to adults with behavioral health or intellectual/developmental disabilities exiting incarceration. Coordinates care linkages involving housing, employment, education, transportation, benefits, treatment, and community services. Builds relationships with justice-system partners, meets recipients in correctional facilities and community settings, supports person-centered planning, and facilitates warm handoffs to ongoing care management and resources.

Leads claims, analysis, and enrollment operations for a managed care organization. Oversees claims adjudication, reconciliation, auditing, reporting, reimbursement procedures, data analysis, compliance, and team performance. Manages staff development and accountability while coordinating cross-functional efforts to improve claims accuracy, payment integrity, and operational efficiency. The role is remote within North Carolina and requires travel within the organization’s service area as needed.

Processes, analyzes, audits, and finalizes claims adjudication results for pre-payment and post-payment reviews. Reviews claim attachments and medical documentation, identifies billing and system errors, applies CMS and NC Medicaid policies, and supports claims resolution. Provides phone and email assistance, training, and technical guidance to providers on claim submission, denials, system updates, and billing requirements. Reports suspected system issues to management.