Provider Network Specialist III

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. Why Work for Us? Trillium believes that empowering others begins with supporting our team. We offer our employees:

• A collaborative, mission-driven work environment
• Competitive benefits and work-from-home options for most positions
• Opportunities for professional growth in a diverse inclusive culture

Every day, our work changes lives - from children thriving through early intervention and school-based therapies, to adults with severe mental illness living independently and contributing to their communities. If you are looking for a unique opportunity to make a tangible impact on the lives of others, apply today! What We’re Looking For Trillium Health Resources has a career opening for a Provider Network Specialist III to join our team! The Provider Network Specialist III supports provider network operations and contributes to the execution of network strategies that strengthen clinical performance. The role collaborates with cross-functional teams to evaluate provider needs, analyze clinical and operational data, and ensure network adequacy, compliance, and effective service delivery. This position plays a key role in guiding providers on quality, performance standards, and improvement opportunities to enhance care outcomes and support organizational goals. On a typical day, you might:

• Apply clinical expertise to support provider network operations and collaborate with colleagues to promote high-quality, person-centered care within the provider network.
• Contribute clinical insight to network development and management activities that strengthen provider performance and support value-based care models.
• Assist in addressing provider performance issues, access barriers, and network gaps by conducting clinical reviews, performing outreach, and supporting coordinated problem resolution.
• Partner with cross-functional teams to align clinical considerations with operational, regulatory, and organizational requirements.
• Participate in continuous improvement activities related to provider performance, clinical outcomes, network quality, and member access.

• Master’s degree and one (1) year of experience in a clinical setting with the MH/SU/IDD population.
• Active North Carolina licensure as:
• Licensed Clinical Social Worker (LCSW)
• Licensed Clinical Mental Health Counselor (LCMHC)
• Licensed Marriage and Family Therapist (LMFT)
• Licensed Psychological Associate (LPA)
• Registered Nurse (RN)
• Must have a valid driver’s license.
• Must reside within North Carolina.
• Must be able to travel within catchment as required.

Preferred:

• Degree in Human Services field.
• Five (5) years of post-Master’s experience in a clinical setting with the MH/SU/IDD population.
• Experience in administrative and operational job duties in clinical setting.
• Certified Professional in Healthcare Quality (CPHQ); Lean Six Sigma Green Belt; and/or Project Management Professional (PMP) or an equivalent project management certification will be accepted.

3.43.4 out of 5 stars United States Remote $68,890 - $92,138 a year - Full-time, Pulled from the full job description

• Loan forgiveness
• Health insurance
• 401(k) matching
• Paid time off
• 401(k) 5% Match
• Flexible spending account
• Paid holidays, Trillium knows that work/life balance is essential. That’s why we offer:
• 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) https://www.myncretirement.gov/systems-funds/local-governmental-employees-retirement-system-lgers/lgers-handbook
• 401k with 5% employer match and immediate vesting
• Public Service Loan Forgiveness (PSLF) qualifying employer
• Quarterly stipend for remote work supplies