Quality Management Specialist II (NE) - IDD

Trillium Health Resources•Lumberton, NC

14d•$56,270 - $69,898•Remote

About The Position

Trillium Health Resources is hiring a Quality Management Specialist II - IDD to ensure Home and Community Based Services (HCBS) for members receiving Residential, Day Support, and Supported Employment are monitored during each member’s plan year. The position also ensures that other monitoring requirements for Innovations Waiver services are followed, with a focus on compliance with the final HCBS rule. The specialist takes a proactive approach to assessment and monitoring and works with the Care Management team to support quality services and consistent adherence to waiver requirements. The role monitors services against state standards, waiver requirements, and applicable Medicaid regulations, including through reviews of service documentation and claims. It promotes member satisfaction through ongoing communication and timely follow-up on concerns. The specialist conducts announced and unannounced member monitoring visits, including nights and weekends as needed, and monitors services in all settings through direct observation, telephone contact, email, and other appropriate methods. The position is remote in North Carolina, with residence required within 75 miles of Trillium’s Southern Region, and travel within the catchment area is required.

Requirements

Meet Qualified Professional (QP) status under North Carolina requirements through one of the following routes: full licensure by the North Carolina governing board for human services professions; full North Carolina RN licensure plus four years of full-time experience with the MH/DD/SA population served; a master’s degree in a human service field plus one year of qualifying full-time MH/DD/SA experience, or qualifying supervised substance-use counseling experience; a bachelor’s degree in a human service field plus two years of qualifying full-time MH/DD/SA experience, or qualifying supervised substance-use counseling experience; or a bachelor’s degree in a non-human-services field plus four years of qualifying full-time MH/DD/SA experience, or qualifying supervised substance-use counseling experience.
If serving members with LTSS needs, meet the minimum QP requirements and have at least two years of prior LTSS and/or HCBS coordination, care delivery monitoring, and care management experience. This experience may be concurrent with the experience required for QP status.
Have a valid driver’s license.
Reside in North Carolina and within 75 miles of Trillium’s Southern Region, which includes Bladen, Brunswick, Columbus, Hoke, Lee, Moore, New Hanover, Robeson, and Scotland counties.
Be able to travel within the catchment area as required.
Be legally authorized to work in the United States without requiring employment sponsorship now or in the future.

Nice To Haves

Professional experience focused on working with individuals with Intellectual Developmental Disabilities (IDD) or Traumatic Brain Injury (TBI) Innovations populations.
Experience with IDD services, monitoring service implementation, and health and safety needs.
Licensure or certification as noted in the QP qualification pathways.

Responsibilities

Monitor services for compliance with state standards, waiver requirements, and applicable Medicaid regulations, including reviewing service documentation and claims.
Promote member satisfaction through ongoing communication and timely follow-up on concerns and issues.
Conduct announced and unannounced monitoring visits to members, including nights and weekends as needed.
Monitor services as needed in all settings through direct observation of service delivery, telephone contact, email, and other methods.
Ensure HCBS for members receiving Residential, Day Support, and Supported Employment are monitored during the member’s plan year.
Ensure other monitoring requirements for Innovations Waiver services are followed.
Work with the Care Management team to support quality services and adherence to waiver requirements.