Trillium Health Resources

Manager

• Provide complex care coordination and monitoring to members with primary Intellectual or Developmental Disabilities and potentially secondary mental health, substance use, or complex medical/physical health needs
• Conduct assessments, monitoring, and complex coordination of care to ensure quality support and adherence to waiver requirements
• Assist with integrated care management through multidisciplinary collaboration and referrals
• Use person-centered planning methods and strategies to gather information and address individual needs
• Educate and support members in learning about and exercising rights and responsibilities
• Complete Discovery activities, including information gathering and assessment, as part of the planning process
• Inform members and legally responsible people about Medicaid and state-funded services, service options, requirements, and natural and community services
• Assist members and legally responsible people in choosing service providers objectively
• Serve children, adolescents, and adults with Intellectual/Developmental Disabilities

Care Manager

Executive Assistant

• Provide administrative support to assist executive leadership priorities, initiatives, and activities
• Prepare and review executive correspondence, reports, presentations, and briefing materials
• Manage executive calendars, including scheduling meetings, coordinating logistics, and prioritizing requests
• Organize and support executive meetings, board activities, and leadership events, including agendas and materials
• Track executive priorities, deliverables, and follow-up actions to support timely decision-making
• Provide high-level administrative support to executive and senior leadership
• Serve as a key liaison for internal and external stakeholders
• Support leadership priorities, governance and leadership activities, and efficient operations and decision-making
• Handle sensitive information

Customer Support

• Provide peer-based support using lived experience to build trust and support engagement in services
• Support outreach and engagement efforts to connect individuals to services and community resources
• Assist individuals in navigating services and accessing available supports
• Facilitate group activities, educational sessions, and community engagement opportunities
• Promote self-advocacy, independence, and active participation in services
• Connect individuals to resources and support participation in care transitions
• Promote recovery, independence, and successful community integration

Peer Support Specialist

General

• Provide professional-level care coordination services within a managed care environment
• Independently conduct comprehensive assessments of member needs using organizational platforms and available data sources
• Provide short-term care coordination services aligned with member needs, benefits, services, and community resources
• Develop, implement, and monitor individualized care plans with members and support teams
• Conduct record reviews to identify care gaps and support care planning and service coordination
• Coordinate services and resources across providers, agencies, and community organizations
• Facilitate member transitions to ensure continuity of care
• Exercise judgment in aligning member needs with appropriate resources

Care Management Specialist II

Full-stack Engineer

• Design, develop, and maintain application solutions
• Apply independent judgment to implement features and resolve issues
• Contribute to system design and support integration
• Ensure reliable and scalable application performance
• Develop and maintain complex SQL code, including stored procedures, functions, views, queries, and data-processing scripts
• Analyze and troubleshoot database issues, including query performance, data discrepancies, failed processes, and production issues
• Work with technical teams to identify and resolve root causes
• Collaborate with Product Owners, Business Analysts, Application Developers, and QA teams to translate business needs into database solutions
• Design, modify, and optimize database structures and data processes, including tables, indexes, relationships, ETL/data movement processes, and SQL queries
• Participate in Agile/Scrum activities, including daily stand-ups, sprint planning, backlog refinement, and reviews
• Manage assigned development work, code reviews, testing, documentation, and deployment activities
• Develop and maintain APIs, integrations, and data processing components

Full Stack Developer II

• 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

Utilization Management Specialist II

Nurse

• Conduct prospective, concurrent, and retrospective clinical reviews using established criteria
• Assess clinical information to determine medical necessity and level of care
• Collaborate with providers and facilities to support treatment planning and discharge coordination
• Perform admission and concurrent reviews to monitor ongoing care needs
• Identify cases requiring physician review and present clinical recommendations
• Coordinate care to ensure appropriate use of services and effective care transitions
• Support discharge planning to improve outcomes and continuity of care

Utilization Management Nurse – Physical Health

• Provide complex care coordination and monitoring to members with primary Intellectual or Developmental Disability and possible secondary mental health, substance use, or complex medical/physical health needs
• Assess, monitor, and coordinate care to ensure quality support and adherence to waiver requirements
• Assist with integrated care management through multidisciplinary collaboration and referrals
• Serve children, adolescents, and adults with Intellectual/Developmental Disability
• Use person-centered planning methods and strategies to gather information and address individual needs
• Educate and support members regarding their rights and responsibilities
• Complete Discovery activities, including information gathering and assessment
• Inform members and legally responsible people about Medicaid and state-funded services, service options, requirements, and natural and community services
• Assist members and legally responsible people in choosing service providers objectively
• Travel within the catchment as required

• Provide complex care coordination and monitoring to members with primary Intellectual or Developmental Disability and possible secondary mental health, substance use, or complex medical/physical health needs
• Conduct assessments, monitoring, and complex coordination of care
• Ensure quality support and adherence to waiver requirements
• Assist with integrated care management through multidisciplinary collaboration and referrals
• Use person-centered planning methods and strategies to gather information and address individual needs
• Provide education and support regarding members' rights and responsibilities
• Complete Discovery activities, including information gathering and assessment
• Inform members and legally responsible people about Medicaid and state-funded services, service options, requirements, and natural and community services
• Assist members and legally responsible people in choosing service providers objectively

Director

• 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

Director, Utilization Management – Review

• Receive and respond to referrals related to unmet health-related resource needs, including housing, food, transportation, and employment
• Connect individuals to community-based organizations and public programs to address identified needs
• Maintain working knowledge of available community resources and service eligibility requirements
• Coordinate referral follow-up to confirm connection to services and identify unresolved needs
• Document referral activities, interactions, and outcomes accurately and within established time frames
• Support access to community-based resources addressing social drivers of health
• Coordinate with community partners to support timely resource navigation

Community Resource Specialist I

Network Engineer

• Support development and ongoing coordination of the provider network
• Engage providers and coordinate onboarding activities
• Monitor provider performance to support network readiness, compliance, and access to services
• Provide service-specific support and quality monitoring for enhanced services serving adults with SPMI
• Apply NC Person-Centered Planning guidance, Clinical Coverage Policy/service definition, and record management standards
• Engage providers in onboarding, readiness, and implementation activities
• Coordinate provider implementation plans and track progress
• Facilitate provider meetings and communication activities
• Support resolution of provider performance issues and gaps
• Collect, analyze, and report data in a timely and accurate manner
• Cultivate collaborative relationships with network providers through technical support and communication outreach
• Evaluate monitoring findings and identify compliance issues
• Coordinate corrective action plans and monitor implementation
• Communicate monitoring results and requirements to providers
• Provide guidance supporting compliance and quality outcomes

Provider Network Specialist II – Adult Behavioral Health

Supervisor

• Provide direct supervision and oversight for an assigned team of localized, multidisciplinary professionals supporting members with intellectual/developmental disabilities or traumatic brain injury
• Ensure staff use Trillium Connections workflows to complete comprehensive care-management assessments and care plans as members’ care needs change
• Establish a team-based, person-centered approach to coordinating members’ physical health, behavioral health, and social-determinant-of-health needs
• Ensure care coordination is performed effectively, efficiently, and in accordance with NCQA procedures
• Monitor teams to help ensure integrated care through multidisciplinary collaboration with members, caretakers/legal guardians, PCPs, behavioral-health and IDD providers, specialists, nutritionists, pharmacists, and others
• Apply evidence-based and industry-standard practices to develop processes, procedures, and workflows for effective care coordination and management

Supervisor, Care Management

• Provide oversight, outreach, engagement, and support for members receiving Tailored Care Management
• Facilitate comprehensive assessments of members' needs and evaluate results
• Initiate and maintain integrated care plans addressing physical health, mental health, social support, lifestyle, community involvement, and risks to well-being
• Serve as the single point of contact for members
• Work with multidisciplinary care teams, including providers, specialists, care manager extenders, transition staff, and caretakers/legal guardians
• Facilitate regular face-to-face and telephonic meetings with members
• Consult with providers to gather and share information relevant to members' care
• Work remotely between 8:30 am and 5:00 pm and travel within the community to meet members and attend meetings as needed

Care Manager

Executive Assistant

Peer Support Specialist

Care Management Specialist II

Full Stack Developer II

Utilization Management Specialist II

Utilization Management Nurse – Physical Health

Care Manager

Care Manager

Director, Utilization Management – Review

Community Resource Specialist I

Provider Network Specialist II – Adult Behavioral Health

Supervisor, Care Management

Care Manager – RCT