Network Development Clinician

TRILLIUM HEALTH RESOURCES

1d • 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 Health Resources has a career opening for a Network Development Clinician to join our team! The Network Development Clinician plays a critical role in ensuring the integrity, quality, and effectiveness of North Carolina’s Medicaid provider network. This position provides clinical expertise in the Credentialing Committee, supports project oversight, conducts network needs assessments, participates in network pre-payment reviews, and contributes to NCQA compliance reviews. The Clinician ensures that providers meet regulatory, ethical, and quality standards while helping strengthen Medicaid’s statewide provider network.

Requirements

• Master’s degree and a minimum of one (1) year post-Master’s experience in a clinical setting with the BH/MH/SU/IDD population.
• Fully licensed by the State of North Carolina as a LCSW, LCAS, LPA, LCMHC, or LMFT.
• Must have a valid driver’s license
• Must reside within North Carolina
• Must be able to travel within catchment as required.

Nice To Haves

• Degree in Human Services field
• Five (5) years post-Master’s experience in a clinical setting with the BH/MH/SU/IDD population.
• Experience monitoring and/or auditing services provided by physical or behavioral healthcare service providers for compliance with Clinical Coverage Policy requirements.

Responsibilities

• Review provider applications flagged for disposition, including enrollment, reenrollment, and recredentialing cases.
• Evaluate monitoring reports for providers identified as medium or high-risk.
• Identify risks, barriers, and opportunities to improve provider participation and access.
• Ensure project requirements, milestones, and reports are completed on schedule.
• Conduct pre-payment provider reviews to ensure compliance with Medicaid participation requirements.
• Provide clinical oversight for network development initiatives.

Benefits

• Typical working hours: 8:30 am – 5:00 pm; flexible work schedules with some roles with management approval.
• Work-from-home options available for most positions
• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 251-500 employees