Grievance Manager

Pay Plan Title: Unit Manager

Working Title: Grievance Manager

Cost Center: 64/Appeals & Grievances

FLSA Status: Exempt

Posting Salary Range: $66,306 - $76,915

Office Location: Remote within North Carolina.

POSTING DETAILS:

Make an Impact  

Trillium Health Resources is a local governmental agency (LME/MCO) in North Carolina that manages serious mental health, substance use, and intellectual/developmental disability services. Serving in 46 counties, we help individuals and their families strengthen well-being and build foundations for a healthy life.

Join our team as we empower others to live their best lives by providing access to quality healthcare. We offer a challenging, engaging work environment where staff take home more than a paycheck. Every day, we see the results of our dedication – in the smiles of children on our accessible playgrounds and in the pride on the face of an adult cooking a meal for the first time. Working at Trillium Health Resources is more than just a job; it is an opportunity to make a direct impact on the communities we serve.

At Trillium, we know that empowering others begins with supporting and developing our team. That’s why we offer competitive benefits and work-from-home flexibility so that our employees thrive outside of the office. We’re also committed to building a diverse, inclusive culture where all employees have the potential to grow professionally and personally.

What We’re Looking For

Trillium Health Resources has a career opening for a Grievance Manager! The core responsibility involves conducting thorough investigations into member and recipient complaints and grievances. This requires a meticulous approach, including in-depth research, maintaining files, making the appropriate referrals and completing follow-ups. Beyond the investigative aspects, this role encompasses a broader scope of responsibilities aimed at ensuring the ongoing effectiveness and compliance at Trillium. An ideal candidate is highly organized, detail-oriented, with a strong understanding of healthcare regulations and the drive to provide exceptional member service. This is an exceptional opportunity to contribute to Trillium's mission of providing quality healthcare. If you have the ability to effectively manage staff, conduct thorough investigations, and communicate clearly, we invite you to apply today!

On a typical day, you might:

• Provide oversight and management of Trillium’s Member and Recipient Grievances and Complaints processes.
   
• Supervise Complaints & Grievances Staff.

• Conduct the investigations related to members and recipient complaints and grievances and provide oversight and guidance on Complaints and Grievances Staff’s complaints and grievances investigations. This includes but is not limited to drafting interview questions, interfacing with provider agencies and internal business units, critically engaging with written documentation and tracking a timeline of events. 
   
• Research, read and interpret controlling authority (coverage policies and service definitions, State and federal statutes and regulations, applicable contracts, agency policies and procedures, etc.)
   
• Review and maintain an investigation file for each complaint and grievance, which includes, among other items, all documents reviewed, interview notes, findings summaries and excerpts of applicable controlling authority. 
   
• Draft resolution complaint and grievance resolution letters in accordance with practices established by the Legal Department and ensure all grievance/complaints are processed and completed timely in accordance with legal and contractual and accreditation standards. 
   
• Prep complaints and grievances files for internal appeals. 
   
• Make referrals of matters related to complaints and grievances to both internal and external parties, as appropriate. 
   
• Complete internal and external follow-up on complaints and grievances, as needed. 
   

• Perform on-going risk management during the complaints & grievances investigation and resolution processes.

Employee Benefits:

Trillium knows that work/life balance is important. That’s why we offer our employees competitive benefits and flexibility that is second to none. Take a look at what we have to offer:

• Typical working hours are 8:30am-5pm

• A remote work option available for most positions
• Health Insurance - no premium for employee coverage
• Flexible Spending Accounts
• Paid Time Off (PTO) of 24 days, plus 12 paid holidays within first year of employment
• NC Local Government retirement pension. This is a defined-benefit retirement plan that will pay you a monthly amount upon retirement, for the rest of your life, with as little as five years of service. For more information, go to: https://files.nc.gov/retire/documents/files/Actives/LGERSHandbook.pdf
• 401k with 5% employer match & immediate vesting
• Public Service Loan Forgiveness Qualifying Employer

Qualifications: 

Education/Experience: 
 High School diploma/GED and five (5) years of experience in conducting complaints and grievance investigations, performing research under the guidance of an attorney or Legal Department, conducting compliance and risk management activities, and drafting correspondence in accordance with practices established by an attorney or Legal Department.

OR

Associate’s degree and three (3) years of experience in conducting complaints and grievance investigations, performing research under the guidance of an attorney or Legal Department, conducting compliance and risk management activities, and drafting correspondence in accordance with practices established by an attorney or Legal Department.

OR

Bachelor’s degree and one (1) year of experience in conducting complaints and grievance investigations, performing research under the guidance of an attorney or Legal Department, conducting compliance and risk management activities, and drafting correspondence in accordance with practices established by an attorney or Legal Department.

OR

Equivalent combination of education/experience.

*A degree in Human services; liberal arts or humanities is preferred. 
 *An advanced degree is also preferred.
 *Supervision of two (2) or more employees and/or experience in the public mental health field, the criminal justice system, or a legal environment is highly desired due to the complexity of the work of the agency.

License/Certification: 
 Must have a valid driver’s license

Location:
 Remote with North Carolina. with North Carolina. 
 Must reside in NC to be considered for remote status. 

Deadline for application: March 31, 2025

To be considered for employment, all candidates are required to submit an application through ADP and upload a current resume.  Your resume must provide your level of education and detailed work experience, including: 

• Employer Name
  1. Dates of service (month & year)
  2. Average number of hours worked per week
  3. Essential duties of the job as related to the position you’re applying for
• Education
  1. Degree type
  2. Date degree was awarded
  3. Institution
• Licensure/certification, if applicable

After submitting your application through our career center in ADP, your resume will be reviewed to ensure that your skills and experience meet the essential criteria for the role you have applied for.

You will be notified by HR on the status of your application as appropriate.  All applicants will receive a final email when the recruitment cycle for the position has closed.  

Join our Talent Community through our ADP career center to stay informed about positions you may qualify for. Remember to keep an update resume in the Talent Community profile. 

The diversity of the communities we serve is reflected in our employees. Trillium Health Resources is an Equal Employment Opportunity (EEO) employer.

Trillium Health Resources is a drug-free workplace. Candidates are required to pass a drug test as a condition of employment.

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