Quality Management Specialist II -IDD

Trillium Health Resources is a Tailored Plan and Managed Care Organization serving individuals with mental health needs, substance use disorders, traumatic brain injuries, and intellectual/developmental disabilities across North Carolina. The Quality Management Specialist II - IDD monitors Home and Community Based Services and Innovations Waiver services for compliance with state standards, Medicaid regulations, and HCBS requirements, while coordinating with Care Management to address quality concerns.

Responsibilities

Monitor services for compliance with state standards, waiver requirements, and Medicaid regulations, as applicable (including review of service documentation, review of claims, etc.)

Promote satisfaction with services through ongoing communication and timely follow-up on any concerns/issues

Make announced/unannounced monitoring visits to members, including nights/weekends as needed

Ensure that services are monitored as needed (including direct observation of service delivery, telephonic contact, emails, etc.) in all settings

Preferred

Professional experience focused on working with individuals with Intellectual Developmental Disabilities (IDD) or Traumatic Brain Injury (TBI) Innovations populations

IDD Population Experience

TBI Innovations Experience

Benefits

Typical working hours: 8:30 am – 5:00 pm; flexible work schedules available for some positions 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

A collaborative, mission-driven work environment

Opportunities for professional growth in a diverse inclusive culture

Company

Specialty behavioral health and disability care manager in North Carolina

Greenville, North Carolina, USA

https://www.trilliumhealthresources.org/

Founded in 1972

1001-5000 employees

Qualifications

Must meet Qualified Professional (QP) status per NC requirements through one of the following:

Fully licensed by the NC governing board regulating human services professions

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

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

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

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

Additionally, if serving members with LTSS needs, must meet the minimum QP requirements defined above and shall additionally have at a minimum two (2) years of prior LTSS and/or HCBS coordination, care delivery monitoring and care management experience. This experience may be concurrent with the years of experience required to become a Qualified Professional

Must have a valid driver's license

Professional experience focused on working with individuals with Intellectual Developmental Disabilities (IDD) or Traumatic Brain Injury (TBI) Innovations populations

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.

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;

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;

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.

Additionally, if serving members with LTSS needs, must meet the minimum QP requirements defined above and shall additionally have at a minimum two (2) years of prior LTSS and/or HCBS coordination, care delivery monitoring and care management experience. This experience may be concurrent with the years of experience required to become a Qualified Professional.

Required skills

Represents the skills you have, click on the tags, Qualified Professional (QP) Status, North Carolina Professional Licensure, LTSS/HCBS Coordination, Care Delivery Monitoring, Care Management, Mental Health/Developmental Disability/Substance Abuse Services, Alcoholism and Drug Abuse Counseling, Intellectual and Developmental Disabilities (IDD) Services, Traumatic Brain Injury (TBI) Services

Experience

2+ years