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Compliance Nurse

Trillium Health Resources

Role overview

Qualifications

  • Associate's degree in Nursing
  • One (1) year of experience with health populations
  • Active North Carolina Licensure as a Registered Nurse (RN)
  • Must have a valid driver’s license

Responsibilities

  • Conduct clinical reviews of pre- and post-payment claims to verify compliance
  • Evaluate clinical documentation against coverage policies and service definitions
  • Apply independent clinical judgment to determine compliance and identify discrepancies
  • Manage assigned compliance cases from intake through resolution

Key facts

Hard skills

Nursing Behavioral Health Internal Documentation Clinical Auditing Continuous Monitoring

Other skills

  • Physical Fitness
  • Communication
  • Problem Solving
  • Teamwork

About the company

Trillium Health Resources logo

Trillium Health Resources

Health Insurance (Payers)

Trillium Health Resources manages specialty behavioral health care for eastern North Carolinians across 28 counties. Trillium is committed to transforming lives and building community well-being through partnership, access to services and proven solutions designed to help those we serve reach their fullest potential. Everyone on Trillium’s staff--our care managers, call center, claims agents, project managers, and IT staff--all contribute to this mission. We offer a challenging, engaging work environment where staff take home more than a paycheck. Our performance management plan includes regular check-ins to examine individual employee goals and professional development plan. Our departments work on cross-functional, short-term projects and long ranging initiatives. Every day we see the results of our dedication, in the smiles of children on our accessible playgrounds and pride on the face of an adult cooking a meal for the first time. By joining Trillium, you are doing more than going to work…you are transforming lives. We help those with mental health conditions, intellectual and developmental disabilities, traumatic brain injury, and substance use disorders (Medicaid members and state-funded recipients) get the services they need to improve well-being and live fulfilling lives. We are dedicated to carrying out our mission by investing in the health and well-being of the communities we serve and empowering individuals with access to services, tools and resources to live a fulfilling life. Trillium reserves the right to hide material (comments, images and/or links to other sites) that contains anything vulgar or sexually explicit; is spam; advocates or depicts illegal activity; targets or disparages any ethnic, racial, other type of group; contains personal attacks of any kind; promotes private business ventures, services, or products; campaigns for public office or promotes a political organization; infringes on copyrights or trademarks; or is off topic.

Company details

Company typeSME
IndustryHealth Insurance (Payers)
Company size501 - 1000

Links

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Job description

Pay Plan Title: Compliance Nurse

Working Title: Compliance Nurse

FLSA Status: Exempt

Posting Salary Range: $68,890 - $92,138

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 Compliance Nurse to join our team! The Compliance Nurse performs clinical compliance reviews and evaluates claims to ensure adherence to regulatory and coverage requirements. The role applies clinical judgment to assess documentation, determine compliance, and direct corrective actions to prevent improper payments and support program integrity.


On a typical day, you might:


  • Conduct clinical reviews of pre- and post-payment claims to verify compliance.
  • Evaluate clinical documentation against coverage policies and service definitions.
  • Apply independent clinical judgment to determine compliance and identify discrepancies.
  • Manage assigned compliance cases from intake through resolution.
  • Investigate allegations of non-compliance.
  • Evaluate case findings and determine appropriate corrective actions.
  • Maintain complete case files in accordance with regulatory and accreditation standards.

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 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


Qualifications


Required:

  • Associate's degree in Nursing and one (1) year of experience with physical health or behavioral health, mental health, substance use, developmental disabilities, and/or co-occurring disorders populations or field.
  • Active North Carolina Licensure as a 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:

  • Experience in both physical healthcare and behavioral healthcare. 
  • Experience in clinical healthcare audits, monitoring or reviews.


Deadline for Application: Monday, August 24, 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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