Trillium Health Resources

Manager

• Ensure claims payment reports are generated and analyzed to determine problems.
• Ensure analysis, research, and corrections are completed in a timely manner to ensure provider payment.
• Assist in developing and maintaining claim processing procedures and ensuring these procedures are understood and followed by claims staff.
• Interact with the provider community to address billing issues.
• Train and mentor staff on claims processing duties to enhance team performance.

Claims Manager

• Lead and manage provider network staff, including performance, coaching, and accountability
• Direct execution of network development and management activities to support provider performance and value-based care
• Monitor provider performance, capacity, and compliance to identify gaps and support network optimization
• Lead resolution of provider performance issues, access barriers, and network deficiencies
• Oversee provider data accuracy and performance analytics to support reporting, decision making, and value-based care initiatives

Manager, Provider Performance

Analyst

• Submit operational reports and contractual deliverables via appropriate systems in a timely manner with extensive attention to detail
• Download reports requiring corrections, share with IT and Business teams for updates, and resubmit within required timeframes
• Download updated technical documents to maintain up-to-date documentation internally
• Analyze information support and participation needs to deliver outcomes that match business needs and IT capacity
• Assist IT Business Integrations Director with various projects as assigned

Senior IT Business Integrations Analyst

Scrum Master

• Assist with long-range planning for enhancement and implementation of future business systems.
• Discover and contribute to the development, implementation, and maintenance of business systems functional architecture, detail systems design, configuration, or program specifications.
• Facilitate daily standups (or the daily scrum) as needed.
• Participate in sprint reviews and capture feedback.
• Provide administrative support for scrum board.
• Ensure cards are up to date and scrum tools are working well.
• Collaborate with team members and other internal stakeholders.
• Perform regular analysis of burndown charts and other portfolio planning tools.

IT Scrum Master

Business Intelligence Developer

• Conducting data analysis activities for Trillium
• Assuring compliance with the DMH and DMA contract requirements as well as other external and internal reporting needs
• Developing and completing reports as well as assisting the Trillium Informatics and Data Science departments
• Develop analytical reports, including data mining, data management, conducting analysis, summarizing, and interpretation of results, to include the identification of patterns and trends in data
• Make recommendations on matters of significance that could impact the agency
• Maintain schedule of external reporting per contracts and internal reporting as requested
• Distribute, interpret and present reports to departmental staff and internal/external committees and/or stakeholders as needed
• Ensure that data from reports are presented in a user-friendly format and made accessible to staff, consumers, and community members
• Ensure all reports include appropriate references to data sources so that reports can be replicated if requested
• Ensure data in reports is accurate and timely
• Reconcile differences between data from different sources
• Ensure all reports are submitted within assigned deadlines to avoid possible penalties or plans of correction
• Use data visualization tools such as Power BI for dashboards and reporting
• Analyze and report statistical data on populations, disabilities, and cultural factors
• Make recommendations on matters of significance that could impact the agency

Business Intelligence Analyst

• Responsible for maintenance of the TCM provider network through effective contract monitoring, relationship development, and provider support.
• Collaborates with Advance Medical Home Plus (AMH+) and Care Management Agency (CMA) providers to ensure that Trillium meets all required benchmarks.
• Responsible for provider oversight and compliance, including meeting facilitation, technical assistance, and monitoring.
• Supervises a team of TCM Coordinators and develops processes and protocols to ensure uniformity in supporting, monitoring, and ensuring contract compliance of all certified and contracted TCM Providers.

Care Management Network Manager

• The RCT (RB-BHT) Care Manager is responsible for providing complex care coordination and monitoring to members having a primary Intellectual or Developmental Disability, which may include a secondary mental health or substance abuse, and/or complex medical/physical health need.
• The RCT (RB-BHT) Care Manager assists with integrated care management through multi-disciplinary collaborations and referrals, including but not limited to: assistance with the TCM opt in/opt out process, completion of care needs screenings, 90 day transition plans, completion/updates of CMCAs and care plan development, and service coordination as needed/deemed appropriate.
• This position has a primary focus on members that have been diagnosed with Autism Spectrum Disorder, particularly children (18mos – 15yo).
• Utilize person centered planning methods/strategies to gather information, to get to know the members supported and to adequately address specific needs of the individual.
• Provide education and support to members in learning about and exercising rights and responsibilities.
• Scheduling and completion of NC Medicaid 1915i Assessment.
• Complete Discovery activities (information gathering and assessment) as a component of the planning process.
• Ensure that members/legally responsible persons are informed of services available (all types of Medicaid and state-funded services), service options available (e.g. Individual/Family Direction for Innovations participants), processes (e.g. requirements for specific service), Natural and community services, and so forth.

Care Manager

• Lead and manage provider relations staff, including performance, coaching, and accountability
• Oversee provider communication, inquiry resolution, and engagement activities across the network
• Monitor provider satisfaction, service levels, and responsiveness to identify trends and improvement opportunities
• Direct resolution of complex provider issues and escalations impacting provider experience
• Analyze provider feedback and inquiry trends to improve communication strategies and service delivery
• Partner with internal teams to resolve cross-functional issues affecting providers

Manager, Provider Relations

• Provide oversight and/or outreach, engagement, and support of members receiving Tailored Care Management.
• Facilitate comprehensive assessments of members’ needs and evaluate results to determine the appropriateness and effectiveness of care.
• Ensure the initiation and continuance of integrated care plans that incorporate a member’s physical health, mental health, social support, lifestyle, community involvement, and risks to well-being, among others.
• Facilitate regular meetings with members, both face-to-face and telephonically.
• Consult with providers to gather and share information relevant to each member’s care including care management comprehensive assessments, and reassessments.

Regional Care Manager – South Central

• Utilize person centered planning methods/strategies to gather information, to get to know the members supported and to adequately address specific needs of the individual.
• Provide education and support to members in learning about and exercising rights and responsibilities.
• Consistently complete Discovery activities (information gathering and assessment) as a component of the planning process.
• Ensure that members/legally responsible people are informed of services available (all types of Medicaid and state-funded services), service options available (e.g. Individual/Family Direction for Innovations participants), processes (e.g. requirements for specific service), Natural and community services, and so forth.
• Assist members/legally responsible people in choosing service providers, ensuring objectivity in the process.

Innovations Waiver Care Manager

Vice President

• Develop and lead Community Oversight/Regional Advisory Boards and support the Consumer and Family Advisory Committee in understanding the performance of the LME/MCO, ensuring that community needs and concerns are represented and addressed appropriately.
• Assist in developing an annual plan of work aligned with the LME/MCO goals.
• Oversee Community Liaison budgets; ensuring reports regarding budgets are prepared for review.
• Establish and maintain community relationships through Community Advisory Councils and participation on external councils, boards and committees.
• Provide direction in the development and streamlining of procedures and processes.

Regional Vice President

Software Engineer

• Analyze and maintain EDI data flows
• Ensure data accuracy and integrity EDI transactions
• Collaborate with IT teams to integrate EDI systems with internal applications
• Troubleshoot and resolve EDI integration issues
• Create and maintain documentation for EDI processes and standards

EDI Developer

Financial Planning and Analysis

• Prepare and review journal entries, accruals, and account reconciliations to ensure accuracy and integrity of the general ledger.
• Analyze financial data and create financial models for forecasting, trending, and results analysis to support business planning and decision-making processes.
• Prepare financial reports and presentations for senior management and stakeholders.
• Prepare and present accurate monthly summary of expenses and direct costs with concise action-oriented commentary and analysis.
• Compile, review, and analyze financial information/statements.

Senior Financial Analyst

Community Manager

• Participate in comprehensive System of Care planning, implementation, coordination, and training related to required core functions within the Region in which it operates.
• Provide education and support to members and families in learning about and exercising rights and responsibilities.
• Serve on a multidisciplinary care team to utilize person-centered planning methods/strategies to gather information, to get to know the members and families/legally responsible persons to adequately address specific needs of the individual.
• Support completion of discovery activities (information gathering and assessment) as a component of the planning process.
• Assist members/legally responsible persons in choosing service providers, ensuring objectivity in the process.
• Assist the member/family supported to direct the planning process/plan development, to the extent desired by the member.

Community SOC Family Partner

• Provide leadership, oversight and supervision for a multidisciplinary team delivering NC Medicaid Tailored Care Management (TCM) services to justice-involved members with behavioral health (BH), intellectual/developmental disabilities (I/DD), and/or substance use (SU) needs.
• Ensure the delivery of whole-person, integrated care management in alignment with NC Medicaid Tailored Plan requirements, including comprehensive assessment, person-centered care planning, care coordination, transition of care, and health promotion.
• Train Coordinators and Health Specialists on systems and processes needed to assist with successful Community re-entry.
• Build from the resources of the community to assist in linking to services that meet the needs of the members and families within their homes and communities.
• Oversee and support staff who coordinate and manage care for members who are participants of the Transitions to Community Living program.
• Lead and support audit readiness and response activities, including NC Medicaid, NCQA, and EQR reviews, ensuring full compliance with Tailored Care Management documentation, service delivery, and performance standards.
• Ensure all care management activities are delivered in a manner that is person-centered, trauma-informed, culturally competent, and compliant with NC Medicaid Tailored Plan requirements, with a focus on improving health outcomes, advancing health equity, and supporting successful community reentry.