[Hiring] Quality Management Specialist II @86242cb5-2fdf-4468-b205-d8aef6aa10d5

Role Description

Trillium Health Resources has a career opening for a Quality Management Specialist II - IDD to join our team! The Quality Management Specialist II - IDD is responsible for ensuring that services for members who receive Home and Community Based Services (HCBS) of Residential, Day Support, and Supported Employment are monitored based on the HCBS requirements during the member’s plan year, as well as ensuring other monitoring requirements for Innovations Waiver services are adhered to. The focus of this position is to ensure compliance with the final HCBS rule. This position requires a dynamic, proactive approach to assessment, monitoring, and working with the Care Management team to ensure quality support and consistent adherence to waiver requirements.

On a typical day, you might:

• 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.

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;
  • OR 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.
  • OR 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;
  • OR 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;
  • OR 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.
• Must reside in North Carolina and within 75 miles of Trillium’s Southern Region, which includes the following counties: Bladen, Brunswick, Columbus, Hoke, Lee, Moore, New Hanover, Robeson, and Scotland.
• Must be able to travel within catchment as required.
• Must be legally authorized to work in the United States without requiring sponsorship for employment now or in the future (ex: OPT F-1, J-1).

Requirements

• Licensure/certification may be accepted as noted above.
• 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.

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.