Provider Outreach to Members

Some providers are encouraging patients to sign up for managed care (i.e. the Standard Plans) and listing the health plans they have contracted with to help patients with health plan selection. We welcome this engagement from our providers, but please note that not all Medicaid members are moving to managed care now. We understand receiving letters or other information from providers to sign up for a health plan is causing some confusion for our members who are not required to sign up at this time.

Members who are not required to sign up include those on the Innovations Waiver or people receiving intensive mental health or substance abuse services.

If you hear from your provider conducting outreach, we encourage you to call the NC Medicaid Enrollment Broker at 833-870-5500 (TTY: 833-870-5588). The enrollment broker can tell you if you are required to sign up for Medicaid Managed Care at this time and can help you with making an informed choice if you are.

Teams & Functions

Breadcrumb

Trillium Health Resources manages care for those with mental health conditions, intellectual/developmental disabilities, and substance use disorders throughout eastern North Carolina. Working collaboratively with community partners, Trillium connects Medicaid recipients, as well as those who are uninsured and underinsured, to critical services they deserve and require. Trillium is focused on transforming lives and building community well-being through partnership, service access, and proven solutions designed to help those we serve reach their fullest potential.

To support this mission, Trillium is organized into functional areas called Teams. Teams incorporate experienced staff who are content experts and focused on the daily operations within their area.

Functional areas consist of Business Management, Care Management and Innovations Waiver, Neighborhood Connections, Network, Contracts and Training, Call Center and Communications, Quality Management, Utilization Management, Legal, Human Resources, Information Technology, and Medical Affairs.

Executive Team

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Leza Wainwright
Chief Executive
Officer
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Cindy Ehlers
Executive Vice President
Clinica Operation
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Joy Futrell
Executive Vice President
Business Operations
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Michael Smith
Chief Medical
Officer
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Mike Lewis
Vice President Technology and Informatics, CIO
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Richard Leissner
General Counsel
 

Regional Operations

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 three 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.

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Bland Baker
Northern Regional Director
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Dave Peterson
Central Regional Director
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Dennis Williams
Southern Regional Director

Business Management

The primary purpose of the Business Management Team is the organization of the fiscal and budgetary operations of Trillium.  The team is responsible for sound financial planning and for ensuring compliance with all fiscal policies at the local, state and federal levels.  The Business Management Team comprises the following areas:  general budget, finance, and claims processing.

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Michelle Martin
Finance Director
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Sheryl Deal
Claims Director

Care Management and Innovations Waiver

Care Management is a person-centered, assessment based interdisciplinary approach to integrating behavioral health services, I/DD services and supports, primary health care, and natural and community social support services. This function is completed in a cost-effective manner in which an individual’s needs and preferences are assessed, a comprehensive care plan is developed, and services are managed and monitored by a care coordinator (if assigned). Through Medicaid Transformation, Care Management will work with providers including Advanced Medical Homes (AMH). 

Care Management at Trillium consists of three regional teams staffed with clinicians and coordinators focused on child, adult, and recipients of the Innovations Waiver. In addition, a Registered Nurse (RN) assists all regions by reviewing care plans and potential services. Care coordinators include qualified professionals, licensed clinicians, coordinators, and peer support specialists.

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Benita Hathaway
Vice President
Care Management
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Juanita Appiah
Director of Care Management
I/DD, TBI, & Innovations Waiver
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Megan Roberson
IDD Clinical Director 
 

Neighborhood Connections

Neighborhood Connections staff help promote healthy opportunities in our communities by focusing on employment, community inclusion, housing, food security, and interpersonal safety. Trillium has a comprehensive list of resources compiled by our Neighborhood Connections department. Neighborhood Connections also will support orientations and training with our members, such as the Eat the Rainbow courses that introduce fruits and vegetables into daily diets. 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. We have three Regional Offices, each with a Regional Operations Director dedicated to your area.

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Maegan Veillette
Unit Director
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Bobbie Lowe
Northern Region Manager
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Melissa Eastwood
Central Region Manager
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Cecelia Peers
Southern Regional Manager

Network Management

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

  • Development: determine needs and recruit new providers
  • Network Engagement: technical assistance & support
  • Practice Management: focused on quality of care along with care access to ensure providers are meeting expectations
  • Early Intervention: addresses potential initiatives to improve health outcomes and increase access to care for our youngest members 
  • Regional Behavioral Health Community Crisis & Disaster Response: assist with coordinating plans and sharing information to prepare for environmental disasters or community crises
  • Network Accountability: 
    • Program Integrity: respond to complaint and grievance reports, provider concerns, and claims on fraud/waste/abuse.
    •  Auditing: conducts several different types of monitoring and reviews of providers to ensure the best possible service delivery and business practices are being carried out within our Network. These include initial site reviews, provider monitoring, UAFL reviews, monitoring of compliance with contract/business requirements, Complaint/Grievance Investigations, and provider concerns.
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Khristine Brewington
Vice President of
Network Management
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Amanda Willett
Head of Program Integrity
 

Contracts and Training  

The Contracts and Training Departments secures all contracts (UCR, non-UCR and professional services) for providers and vendors, coordinates training offered to both providers and the public, and reviews addendums and contract revisions as necessary.

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Luz Terry
Contracts & Training Director

Call Center and Communications

The Call Center & Member Engagements team is staffed with experienced agents, qualified professionals, and licensed clinicians whose primary purpose is to give members 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. The 24-Hour Access to Care Line is available 24 hours a day, seven days a week, 365 days a year.

The Call Center also assists with collecting information on complaints and grievances from members, 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. 

Housing Services works with community representatives and agencies to help secure decent, safe, and affordable housing for members. Trillium Housing staff work closely with community partners to coordinate efforts, avoid duplication and obtain the best outcomes for people serve.

The Communications and Marketing department creates printed and digital resources to educate members and their family, providers, and the public. These brochures, websites and other materials help explain the services coordinated by Trillium, along with information about managed care organizations (MCO) and the Medicaid system in North Carolina. Communications helps promote Trillium to the broader communities we serve through corporate sponsorships and our social media accounts.

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Jennifer Mackethan
Communications and Marketing Director
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Amy Modlin
Head of Housing
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Ashley Rhea
Call Center and Member Services Director
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Paige Fuqua
Member Engagement Manager
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Christie Edwards
Vice President of Clinical Operations

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

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Fonda Gonzales
Director of Quality Management

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.

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Cham Trowell
Head of Utilization Management

Legal Team

Appeals responds to requests for the review of an Adverse Benefit Determination for Medicaid recipients. Medicaid recipients have the right to appeal decisions made about service requests. State-funded services are not an entitlement, but in some circumstances, denials can be appealed.

Internal Compliance confirms that departments within Trillium follow state and federal contracts, guidelines, and regulations. Internal Compliance initiates annual and ad-hoc audits to ensure adherence to all of Trillium’s policies and procedures and contractual obligations.

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Kimberly Huneycutt
Internal Compliance and Medicaid Contract Manager

Human Resources

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.

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Tammy Perry
Human Resources Director

Information Technology

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
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Patrick Hinnant
Technology Director
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Chris Penrod
Informatics Director

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.

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Dr. Kim Greer, PhD
Staff Psychologist
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Dr. Paul Garcia
Medical Director of Utilization Management

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