Network Auditing Coordinator

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🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $56.3k - $69.9k / year

⏰ Full Time

🟢 Junior

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Trillium Health Resources

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

⚕️ Healthcare Insurance

Healthcare Insurance • Mental Health • Substance Use

Trillium Health Resources is a leading specialty care manager (LME/MCO) for individuals with serious behavioral health, intellectual/developmental disabilities, and traumatic brain injury in North Carolina. The organization is committed to investing in the health and well-being of the communities it serves, providing services such as preventive health screenings, crisis intervention, and tailored care management. Trillium focuses on enhancing access to mental health and substance use services for its members and ensuring support for vulnerable populations.

📋 Description

• Maintain network quality by performing provider monitoring to ensure compliance with rules, regulations and service definition requirements. • Facilitate the resolution of deficiencies through the issuance, review and acceptance of Plans of Corrections (POC) and monitoring implementation of these plans. • Establish a partnership and collaboration with Trillium Health Resources Network providers by providing technical assistance/guidance, facilitating communication, and possible inclusion in various committees as necessary. • Conduct quality audits in an objective, systematic, unbiased manner. • Ensure that quality health care determinations are being made based on the provider’s contract/policies and procedures/accreditation standards, as well as federal and state laws/mandates. • Implement and maintain Inter-rater Reliability when conducting reviews.

🎯 Requirements

• Must meet Qualified Professional (QP) status. • Fully licensed by the NC governing board regulating Human Services professions; OR • Fully licensed RN who is licensed to practice in the state of NC by the NC Board of Nursing who also has four (4) years of full-time experience with the MH/DD/SA population served; OR • A graduate of a college or university with a Master’s degree in a human service field and has one year of full-time, pre or post-graduate degree accumulated MH/DD/SA experience with the MH/DD/SA population, or a substance abuse professional who has one year of full-time, pre or postgraduate degree accumulated supervised experience in alcoholism and drug abuse counseling; OR • A graduate of a college or university with a bachelor's degree in a human service field and has two years of full-time, pre or post-bachelor's degree accumulated MH/DD/SA experience with the MH/DD/SA population, or a substance abuse professional who has two years of full-time, pre or post bachelor's degree accumulated supervised experience in alcoholism and drug abuse counseling; OR • A graduate of a college or university with a bachelor's degree in a field other than human services and has four years of full-time, pre or post-bachelor's degree accumulated MH/DD/SA experience with the MH/DD/SA population, or a substance abuse professional who has four years of full-time, pre or post-bachelor's degree accumulated supervised experience in alcoholism and drug abuse counseling. • Must have a valid driver’s license. • Must reside within 75 miles of Trillium’s South Central Region, which includes the following counties: Carteret, Craven, Duplin, Jones, Lenoir, Onslow, Pender, Sampson, and Wayne. • Must be able to travel within catchment as required.

🏖️ Benefits

• 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