Pay Plan Title: Coordinator
Working Title: Member Appeals Liaison
FLSA Status: Exempt
Posting Salary Range: $54,106 - $67,210
Office Location: Remote within North Carolina
POSTING DETAILS:
Make an Impact
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 Member Appeals Liaison to join our team! The Member Appeals Liaison is responsible for identifying and closing care gaps in the course of Medicaid appeals decisions. This includes researching cases prior to mediations and/or State Fair Hearings before the North Carolina Office of Administrative Hearings; participating in case staffings with the Appeals and Medical teams; communicating with members, guardians, providers, and care managers before and after mediations and State Fair Hearings; participating in mediations and State Fair Hearings; and documenting coordination efforts and outcomes. While primarily responsible for Medicaid appeals, this position may be involved in the State appeals panel process for State-funded services and will be expected to perform additional duties as needed to support the appeals process.
On a typical day, you might:
- Research treatment history, current medical needs, alternative treatment options, access to providers, and available natural supports for members requesting mediations and State Fair Hearings (SFHs)
- Participate in member appeal mediations and SFHs in order to gather information on necessary follow-up activities
- Consult with the legal team on strategy for mediations and SFH
- Communicate with members, guardians, providers, and/or care managers to ensure any recommendations and/or court orders are enacted following the appeals process
- Prepare supportive evidence for the legal team to use during SFHs
Employee Benefits:
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 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) 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
Qualifications
Required:
- Must meet Qualified Professional (QP) status:
- 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.
- Must have a valid driver’s license.
- Must reside within North Carolina.
- Must be able to travel within catchment as required.
Preferred:
- License and/or certification may be accepted as noted above
- Degree in a medical field
- Prior Medicaid appeals experience
- Experience working in an integrated health practice setting or as an integrated health care manager
Deadline for Application: Wednesday, June 10, 2026 at 11:59pm
How to Apply
To be considered, submit your application and resume through our ADP Career Center. Your resume must include:
- Employer name, dates of service (month/year), average hours worked per week, and essential job duties
- Education details (degree type, date awarded, institution, field of study)
- Licensure/certification information, if applicable
After submission, your resume will be reviewed to ensure it meets the essential criteria for the position. You’ll be notified by HR regarding your application status as appropriate. All applicants will receive a final update once the recruitment cycle closes.
Join our Talent Community through ADP to stay informed about future opportunities. Be sure to keep your resume updated in your profile.
Trillium Health Resources is an Equal Employment Opportunity (EEO) employer and a drug-free workplace. All candidates must pass a drug test as a condition of employment.
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