The Compliance Nurse performs clinical compliance reviews and evaluates claims to ensure adherence to regulatory and coverage requirements. They apply clinical judgment to assess documentation, determine compliance, and direct corrective actions to support program integrity.
Requirements overview
Candidates must hold an Associate's degree in Nursing and possess an active North Carolina Registered Nurse (RN) license. At least one year of experience in physical or behavioral health, mental health, substance use, or developmental disabilities is required.
Trillium Health Resources manages specialty behavioral health care for North Carolinians across 46 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.
HealthcareGovernment & Public SectorSocial Services
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 [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: Friday, October 16, 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.
#Innovation #Technology #Careers #NorthCarolina #BehavioralHealth
Requirements
•Clinical compliance reviews
•Claims evaluation
•Regulatory compliance
•Clinical documentation
•Corrective actions
•Program integrity
•Clinical judgment
•Case management
•Investigation
•Healthcare auditing
•Registered Nurse
•Behavioral health
•Physical health
Benefits
•Health Insurance
•Flexible Spending Accounts
•Paid Time Off
•Paid Holidays
•NC Local Government Retirement Pension
•401k with 5% employer match
•Public Service Loan Forgiveness
•Quarterly stipend for remote work supplies
Ready to apply?
Jigup is invite-only right now. Join the waitlist to save jobs, track applications, and build tailored resumes.
TRILLIUM HEALTH RESOURCES•North Carolina, United States