Quality Management Specialist III - Population Health

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/developmental (IDD) disabilities. Our mission is to help individuals and families build strong foundations for healthy, fulfilling lives.

About the role

The Quality Management Specialist III - Population Health is responsible for developing policies, procedures, practices, and systems that support the provision of care management services. This role demonstrates clinical expertise for specific complex and/or rising risk member populations, identifies members appropriate for population health programs using data informatics, and provides interventions and education to promote health prevention and promotion.

Responsibilities

• Develop, review, and evaluate operating policies, practices, and procedures with department-wide impact and provide critical feedback on outcomes to enhance effectiveness.
• Manage, review, and analyze operations and services for adherence to program goals and objectives using databases, dashboards, performance outcome data, and reports. Recommend changes based on analyses.
• Collaborate with internal teams to identify gaps or opportunities for improved workflows or process changes for special populations.
• Serve as a subject matter expert regarding identified special populations, regulatory requirements, policies, procedures, programs, and staff support; provide staff education and training on relevant program components.
• Oversee utilization of resources used by specialty populations, e.g., coordination of secure transportation requests.

Qualifications

• Bachelor’s degree in Nursing and one (1) year of experience providing care to individuals with complex physical, chronic, and/or behavioral health conditions; OR Master’s degree in a Health or Human Services field and one (1) year of experience providing care to individuals with complex physical, chronic, and/or behavioral health conditions.
• Fully licensed by the state of North Carolina as an LCSW, LCMHC, LPA, LMFT, LCAS, or RN.
• Valid driver’s license.
• Must reside within North Carolina and be able to travel within the catchment area as required.

Preferred Qualifications

• At least one (1) year of clinical policy review, conducting audits, or quality improvement review experience.

Benefits

• Typical working hours: 8:30 am – 5:00 pm; flexible work schedules with some roles requiring 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.

Pay

$68,890 - $92,138