Equipos y Funciones

El objetivo principal del equipo de Gestión Empresarial es organizar las operaciones fiscales y presupuestarias de Trillium. El equipo es responsable de una planificación financiera sólida y de garantizar el cumplimiento de todas las políticas fiscales a nivel local, estatal y federal. El equipo de Gestión Empresarial está compuesto por las siguientes áreas: presupuesto general, finanzas y tramitación de reclamaciones.

La Administración de Cuidados es un enfoque interdisciplinario centrado en la persona y basado en evaluaciones para integrar servicios de salud conductual, servicios y apoyos para Discapacidad Intelectual y/o del Desarrollo (DID), cuidados primarios de salud y servicios de apoyo social natural y comunitario. Esta función se completa de una manera rentable en la que se evalúan las necesidades y preferencias de una persona, se desarrolla un plan de cuidados completo y los servicios son administrados y monitoreados por un administrador de cuidados que es asignado.

La Administración de Cuidados en Trillium consta de equipos regionales consta de médicos y coordinadores centrados en el comportamiento de niños y adultos, y miembros de la exención Innovations. Además, las enfermeras registradas (RN) ayudan a todas las regiones revisando los planes de cuidados y los servicios potenciales. La Administración de Cuidados puede incluir profesionales calificados, médicos autorizados, coordinadores y especialistas en apoyo de pares.

El departamento de Comunicaciones y Mercadeo crea recursos impresos y digitales para educar a los afiliados y sus familias, los proveedores y el público. Estos folletos, sitio de internet y otros materiales ayudan a explicar los servicios coordinados por Trillium, junto con información sobre organizaciones de cuidados administrados, planes personalizados y el sistema de Medicaid en Carolina del Norte. Las comunicaciones ayudan a promover Trillium entre las comunidades más amplias a las que servimos a través de patrocinios corporativos y nuestras cuentas de redes sociales.

Colabora, desarrolla y ejecuta un Plan Estratégico de Capacitación que se alinea y respalda la dirección estratégica general de la empresa.

Evalúa los programas de capacitación, las herramientas, el diseño instruccional y las plataformas de aprendizaje actuales y modifica el contenido y el enfoque basándose en las mejores prácticas en la clase.

El Departamento de Capacitación coordina la capacitación ofrecida tanto a los proveedores como al público, incluyendo el Equipo de Intervención de Crisis y Primeros Auxilios de Salud Mental. El departamento de Capacitación supervisa My Learning Campus, la plataforma de aprendizaje en línea gratuita que proporciona al público hojas de consejos y capacitaciones grabadas.

El personal del equipo de Asesoría General responde a solicitudes de revisión de una Determinación Adversa de Beneficios para beneficiarios de Medicaid, apelaciones y solicitudes de reconsideración. Los afiliados de Medicaid tienen derecho a apelar las decisiones tomadas sobre solicitudes de servicios. Los servicios con fondos estatales no son un derecho, pero en algunas circunstancias, los beneficiarios pueden apelar las negaciones.

El cumplimiento confirma que los departamentos de Trillium siguen los contratos, directrices y regulaciones estatales y federales. Inician auditorías anuales y ad hoc para garantizar el cumplimiento de todas las políticas, procedimientos y obligaciones contractuales de Trillium.

El Programa de Integridad responde a informes de quejas y reclamos, inquietudes de proveedores y reclamos sobre fraude, malgasto y/o abuso.

The Human Resources team ensures Trillium is staffed with a highly competent workforce that supports its mission. Trillium retains qualified employees through a competitive salary and benefits package, training and development opportunities, and practices that treat employees with respect and equality.

The Information Technology teams strengthen Trillium’s use of information, analytics, and technology for both staff and members served. IT staff from both the Business Informatics and IT Operations teams work collaboratively across departments to:

• secure all data and ensure compliance with all IT standards;
• innovate the application of new technologies to improve organization operations;
• develop reports and applications based on business and clinical needs;
• implement software to provide staff with the tools to improve care coordination and facilitate record sharing; 
• maintain databases and information systems;
• support hardware and equipment supplies for the organization; respond to provider requests for technical assistance with online portals and access;
• oversee physical plant operations

Housing Services: Works with community representatives and agencies to help secure decent, safe, and affordable housing for members.

Head of Supports Intensity Scale: The Supports Intensity Scale (SIS) reflects a positive way of thinking to focus on the support needs for individuals with intellectual/developmental disabilities (I/DD) to be successful. The SIS results will provide useful information for development of Individual Support Plans (ISP) because it gathers a wealth of information about an individual’s support needs. 

Head of Specialty Care: Helps secure assistive devices, house modifications, and technology for individuals to live as independently as possible. 

Neighborhood Connections: Promotes healthy opportunities in our communities by focusing on employment, community inclusion, housing, transportation, education, food insecurity, and interpersonal safety/toxic stress.

Trillium maintains relationships with community-based organizations that offer resources for unmet health-related resource needs. Staff also engage with members and recipients in community settings to improve access to resources that address unmet health-related resource needs and promote wellness and stability practices.

Head of Registry of Unmet Needs: Tracks individuals who have applied for the Innovations Waiver to help identify potential services that can assist while they await their slot. 

DSS Engagement and Strategy: Develops relationships with local Departments of Social Services (DSS) to determine specialized needs for each county and maintains open communication.

The Member Services team is staffed with experienced agents, qualified professionals, and licensed clinicians whose primary purpose is to give members/recipients and their families, providers, and other community stakeholders accurate and relative information in regards to Trillium, our network of providers, and the services that are available. Our Member and Recipient Service is staffed to help answer questions about services available and connect members/recipients with providers.

Member Services staff also assist with collecting information on complaints and grievances from members/recipients, family, guardians or providers. Member Engagement staff explore innovative ways to reach individuals who may benefit from services but have not been introduced to Trillium.

Innovative Development oversees exciting projects such as the launch of the mobile care units, and develops appropriate additions to our Value-Added Services (Trillium Advantage) and In Lieu of Services.

Medical Affairs

The Medical Affairs team includes Trillium’s medical officers who provide clinical oversight to all clinical components within Trillium. The medical officers ensures Trillium’s objective to have qualified clinicians accountable to the organization for decisions affecting members.

The medical officers assist in the following capacities:

• Chairperson of the Quality Improvement Committee
• Member of the Global Quality Improvement Committee
• Consultation with Utilization Management and the Call Center on complex situations
• Oversight of the Credentialing Program for Providers
• Communication of clinical policy from NC DHHS

Staff in the Medical Affairs team helped launch the Child First initiatives, and maintain support for the agencies operating these programs.

Utilization Management

Utilization Management reviews, manages, and monitors the use of mental health, substance use, and intellectual/developmental disability services. UM also reviews utilization data to evaluate and ensure that services are being provided appropriately within established benchmarks and clinical guidelines and that services are consistent with the authorization and approved plan. Their goal is to ensure that members receive the right service, at the right time, at the right level, while creating the most effective and efficient treatment possible.

Quality Management

The Quality Management Program is a comprehensive, proactive program that provides the structure, process, resources, and expertise necessary to systematically define, evaluate, monitor and ensure that high-quality, cost-effective care and services are provided to members. Additionally, they ensure that compliance with national accreditation standards is met and ongoing throughout the term of the contractual agreement.

This program includes a continuous, objective, and systematic process that:

• monitors and evaluates key indicators of care and services
• identifies opportunities for improvement
• develops and implements interventions that address the identified opportunities
• re-assess to demonstrate the effectiveness of applied program interventions

Trillium’s provider network is managed and maintained through efforts of the Network Management Department. They are responsible for the development and maintenance of the provider network to ensure we meet the needs of members and recipients while ensuring choice and best practices in services. Network oversees the following:

• Network Development: determine needs and recruit new providers
• Provider Relations: Answers inquiries and provides support to contracted providers
• Practice Management: focused on quality of care along with care access to ensure providers are meeting expectations
• Network Accountability: Includes Auditing (initial site reviews, monitor compliance, and complaint investigations) and Monitoring (monitors contracts and performance activities)

Trillium Health Resources is widely accessible and deeply integrated into our communities to help improve access, reduce administrative burdens on providers, and increase the quality of services. To do this, we have five Regional Offices, each with a Regional Operations Director dedicated to your area.

Each region has a Regional Advisory Board to ensure the local voice is heard on the Trillium Governing Board. The Governing Board collaboratively plans, budgets and monitors Trillium operations. It is composed of an equal number of members from each Regional Advisory Board. This two-tiered governing structure allows for accountability of services within our communities, a local service model and local advocacy opportunities for individuals and family members.

Community Liaisons attend meetings and events in their local communities to help in these efforts.