Network Auditing Coordinator

TRILLIUM HEALTH RESOURCES

3d•Remote

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 Network Auditing Coordinator to join our team! The Network Coordinator will support the development and management of the Provider Network for members who have been identified as having Mental Health, Developmental Disabilities or Substance Use needs and will be responsible for overseeing the monitoring activities of the provider network. This position will be responsible for maintaining knowledge of applicable Federal, State, and Accreditation requirements and ensuring that the organization maintains compliance with these requirements.

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 Trillium’s South Central Region or within 75 miles, which includes the following counties: Carteret, Craven, Duplin, Jones, Lenoir, Onslow, Pender, Sampson, Wayne.
Must be able to travel within catchment as required.

Nice To Haves

Human Services degree

Responsibilities

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.