[Hiring] Provider Network Specialist II @TRILLIUM HEALTH RESOURCES

Role Description

Trillium Health Resources has a career opening for a Provider Network Specialist II to join our team! The Provider Network Specialist II supports development and ongoing coordination of the provider network. The role engages providers, coordinates onboarding activities, and monitors performance to support network readiness, compliance, and access to services. In addition to these core responsibilities, the position provides service-specific support and quality monitoring for enhanced services serving adults with SPMI. Must be knowledgeable in NC Person-Centered Planning guidance, Clinical Coverage Policy/service definition and record management standards. This highly collaborative role requires strong team-building skills and the ability to work independently.

On a typical day, you might:

• Engage providers to support onboarding, readiness, and implementation activities.
• Coordinate provider implementation plans and track progress.
• Monitor provider performance and compliance with requirements.
• Facilitate provider meetings and communication activities.
• Support resolution of provider performance issues and gaps.
• Collect, analyze, and report data in a timely and accurate manner.
• Cultivate strong, collaborative relationships with network providers by offering technical support and facilitating clear, consistent communication and outreach.
• Evaluate monitoring findings and identify compliance issues.
• Coordinate corrective action plans and monitor implementation.
• Communicate monitoring results and requirements to providers.
• Provide guidance to support compliance and quality outcomes.

Qualifications

• High school diploma or GED and six (6) years of experience with medical practices, clinical settings, managed care organizations, provider relations, network development, or provider contracting; OR
• Associate's degree in a field related to population health, healthcare administration, business administration, health, psychology, sociology, social work, nursing, or other human services and four (4) years of experience with medical practices, clinical settings, managed care organizations, provider relations, network development, or provider contracting; OR
• Bachelor's degree in a field related to population health, healthcare administration, business administration, health, psychology, sociology, social work, nursing, or other human services and two (2) years of experience with medical practices, clinical settings, managed care organizations, provider relations, network development, or provider contracting; OR
• Equivalent combination of education and experience.
• Must have a valid driver’s license.
• Must reside within Trillium’s Catchment of North Carolina.
• Must be able to travel within catchment as required.

Requirements

• One (1) year of work experience in mental health, substance use, or developmental disabilities, preferably on teams such as Assertive Community Treatment (ACT), Community Support Team (CST), and/or Transition Management Services (TMS).
• Experience in the development of Person-Centered Plans (PCPs) and the understanding of the NC DHHS Person-Centered Planning guidance.
• Strong data driven approach with the ability to analyze trends and present findings.
• Proficiency with Excel and other tools used for data tracking, analysis, and reporting.

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.

Company Description

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.