Compliance Nurse
About The Position
Trillium Health Resources is a Tailored Plan and Managed Care Organization (MCO) serving 46 counties across North Carolina. We manage services for individuals with serious mental health needs, substance use disorders, traumatic brain injuries, and intellectual/development (IDD) disabilities. Our mission is to help individuals and families build strong foundations for healthy, fulfilling lives. Trillium believes that empowering others begins with supporting our team. We offer our employees a collaborative, mission-driven work environment, competitive benefits and work-from-home options for most positions, and opportunities for professional growth in a diverse inclusive culture. Every day, our work changes lives – from children thriving through early intervention and school-based therapies, to adults with severe mental illness living independently and contributing to their communities. If you are looking for a unique opportunity to make a tangible impact on the lives of others, apply today! Trillium Health Resources has a career opening for a Compliance Nurse to join our team! The Compliance Nurse performs clinical compliance reviews and evaluates claims to ensure adherence to regulatory and coverage requirements. The role applies clinical judgment to assess documentation, determine compliance, and direct corrective actions to prevent improper payments and support program integrity.
Requirements
- Associate's degree in Nursing and one (1) year of experience with physical health or behavioral health, mental health, substance use, developmental disabilities, and/or co-occurring disorders populations or field.
- Active North Carolina Licensure as a Registered Nurse (RN).
- Must have a valid driver’s license.
- Must reside within North Carolina.
- Must be able to travel within catchment as required.
Nice To Haves
- Experience in both physical healthcare and behavioral healthcare.
- Experience in clinical healthcare audits, monitoring or reviews.
Responsibilities
- Conduct clinical reviews of pre- and post-payment claims to verify compliance.
- Evaluate clinical documentation against coverage policies and service definitions.
- Apply independent clinical judgment to determine compliance and identify discrepancies.
- Manage assigned compliance cases from intake through resolution.
- Investigate allegations of non-compliance.
- Evaluate case findings and determine appropriate corrective actions.
- Maintain complete case files in accordance with regulatory and accreditation standards.
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
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
