[Hiring] Quality Management Specialist III @TRILLIUM HEALTH RESOURCES

Role Description

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 is also responsible for demonstrating clinical expertise for specific complex and/or rising risk member populations and will work to identify members that are appropriate for population health programs utilizing data informatics, along with providing interventions and education to promote health prevention and promotion.

On a typical day, you might:

• 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 provided for adherence to program goals and objectives utilizing 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 population e.g. coordination of secure transportation requests for special populations.

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.
• Must have a valid driver’s license.
• Must reside within North Carolina.
• Must be able to travel within catchment as required.

Requirements

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

Benefits

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