Compliance Nurse

Trillium Health Resources; Raleigh (NC); Remote; USD 69,000 - 92,000; Full time

Benefits offered by this job

Health Insurance

Flexible Spending Accounts

PTO 24 days

Paid holidays 12

Pension with 5% match

PSLF eligible employer

Remote work stipend

Job summary

Trillium Health Resources is seeking a Compliance Nurse to perform clinical compliance reviews and evaluate claims to ensure adherence to regulatory and coverage requirements. The role requires an Associate's degree in Nursing, NC RN licensure, valid driver’s license, NC residency, and the ability to travel within the catchment; remote NC work is supported.

Daily tasks include reviewing pre- and post-payment claims, auditing documentation against policies, directing corrective actions, and

Qualifications

• Associate's degree in Nursing and one year of experience in 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.

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.
• Investigate allegations of non-compliance.
• Evaluate case findings and determine appropriate corrective actions.
• Maintain complete case files in accordance with regulatory and accreditation standards.

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?

• 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,

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.
• 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) systems-funds/local-governmental-employees-retirement-system-lgers/lgers-handbook401k 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

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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