Professional Management Enterprises, Inc.

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MuncieIN Contract Mar 28, 2024 Healthcare Provide resources who are trusted members of the communities served and/or have an unusually close understanding of the communities to facilitate access to health care services, improve the quality and cultural competency of those services, and improve member health outcomes. Outreach Coordinator Resources work to increase health literacy, reduce costs of services, and improve care.  The overall approach for outreach workers is fluid and flexible based on identified quality and member outcome needs. The primary focus of the Outreach resources will be as follows:   Understand Member history and the physical, behavioral, and social factors that may be leading to less-than-ideal health outcomes or persistent gaps in care. Utilize a whole health approach when interacting with Members and caregivers. Working with Case Management to place outreach resources at point of care facilities to better facilitate member engagement and action. Facilitate real time gap closure initiatives including but not limited to immunizations, telehealth visits, A1c tests, lead tests, and blood pressure readings. Pivot priorities as necessary month to month based on HEDIS performance. Engage member in care coordination and case management as necessary. Educate member on health care benefits and services and monitor for over and/or underutilization  
ColumbiaSouth Carolina Contract Mar 28, 2024 Other Area(s) Seeking an RN with Managed Care and Utilization Management experience to review and evaluate medical or behavioral eligibility regarding benefits and clinical criteria. This position is remote, but requires the candidate to reside in the state of S.C. The scheduled is M-F 8:30am-5:00pm. Utilizes clinical proficiency and claims knowledge/analysis to assess, plan, implement, health coach, coordinate, monitor, and evaluate medical necessity and/or care plan compliance, options, and services required to support members in managing their health, chronic illness, or acute illness. Utilizes available resources to promote quality, cost effective outcomes. Performs medical or behavioral review/authorization process. Ensures coverage for appropriate services within benefit and medical necessity guidelines. Assesses service needs, develops and coordinates action plans in cooperation with members, monitors services and implements plans. Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions.    
ColumbiaSouth Carolina Contract Mar 28, 2024 Other Area(s) Seeking an RN with Managed Care and Utilization Management experience to review and evaluate medical or behavioral eligibility regarding benefits and clinical criteria. This position is remote, but requires the candidate to reside in the state of S.C. The scheduled is M-F 8:30am-5:00pm. Essential Duties: Review and evaluate medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and established clinical criteria to service requests or provides health management program interventions.   Utilizes clinical proficiency, claims knowledge/analysis, and comprehensive knowledge of healthcare continuum to assess, plan, implement, coordinate, monitor, and evaluate medical necessity, options, and services required to support members in managing their health, chronic illness, or acute illness.  Utilizes available resources to promote quality, cost effective outcomes. Preferred Skills and Abilities: Working knowledge of Microsoft Office Excel, Access, or other spreadsheet/database software. Thorough knowledge/understanding of claims/coding analysis, requirements, and processes. Required Experience: 3 years recent clinical in defined specialty area. Specialty areas include: oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review/case management/clinical/or combination; 2 of the 4 years must be clinical. Required Education: Associate Degree - Nursing, OR, Graduate of Accredited School of Nursing. PME is an equal opportunity employer. We prohibit discrimination and harassment against any applicant or employee based on any legally recognized basis, including, but not limited to: veteran status, uniformed servicemember status, race, color, religion, sex, sexual orientation, gender identity, age (40 and over), pregnancy, national origin or ancestry, citizenship status, physical or mental disability, genetic information (including testing and characteristics) or any other category protected by federal, state or local law.  
StauntonIllinois Contract Mar 28, 2024 Other Area(s) PME is looking for a RN Case Manager I experienced in Case Management working with complex medical and mental illness cases. The position requires face to face member visits. Schedule M-F 8:30am-5:00pm CST. The Candidates MUST reside within Macoupin County.  Summary Responsible for health care management and coordination of healthcare members Works with members to create and implement an integrated collaborative plan of care. Conducts assessment of member needs by collecting in-depth information from healthcare information system, the member, member’s family/caregiver, hospital staff, physicians, and other providers. Develops and implements a case management plan in collaboration with the member, care team. Familiarity with NCQA standards, state/federal regulations, and measurement techniques. In depth knowledge of CCA and/or other Case Management tools. Requirements Healthcare Case Management experience Active, unrestricted State RN license or Licensed Clinical Social Worker (LCSW or LMSW) in good standing 0-2 years of clinical experience with case management experience PME is an equal opportunity employer. We prohibit discrimination and harassment against any applicant or employee based on any legally recognized basis, including, but not limited to: veteran status, uniformed servicemember status, race, color, religion, sex, sexual orientation, gender identity, age (40 and over), pregnancy, national origin or ancestry, citizenship status, physical or mental disability, genetic information (including testing and characteristics) or any other category protected by federal, state or local law.  
IndianapolisIndiana Contract Mar 28, 2024 Administrative Job Summary: The trainer is responsible for facilitation of a range of training content, primarily for Indiana early childhood education professionals and program leaders, SPARK IN staff/partners, and for broader external audiences. **This position is remote, with travel to provide training coverage of Central Indiana.** Pay:   Up to $65,000 a year Essential Duties & Responsibilities: Supports the implementation of technical assistance initiatives, including online and in-person learning opportunities, learning management system administration, and content development processing and cataloging.  Provides virtual and in-person learning opportunities Completes responsibilities on the learning management system Completes all aspects of the training process, including identification of training needs; provides input in the design and development of learning solutions (content/materials); direct facilitation of training sessions; and learning transfer and evaluation. Evaluates data to inform and improve training opportunities Participates in assigned meetings, events, training and conferences as required. Non-Essential Duties: Contributes to other Professional Development projects as needed. Performs any and all other duties as assigned. Job Specifications: To perform this job successfully, an individual must be able to carry out each essential duty in a satisfactory manner. The job specifications listed are representative of the education and experience, the physical requirements, as well as the knowledge, skill and/or ability (KSAs) that are generally necessary for the role. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Job Requirements: Master’s degree required. Focus on Early Childhood or related field Minimum three (3) years of cumulative experience in related fields, which may include Head Start or other early childhood education, family/community engagement, or program design & management Experience with in-person and virtual training/facilitation (in an educational setting a plus) Physical exam and background checks are required for this position. Travel required locally or long-distance up to 20% of the time for work-related meetings and functions. Must have a valid driver’s license and/or reliable transportation. Knowledge, Skills, & Abilities: Bilingual (Spanish) desirable Extraordinary facilitation, presentation and general interpersonal skills. Knowledge of Shine Early Learning offerings/partners a plus; or, ability to get up-to-speed quickly. Ability to navigate a complex organizational structure, assess and balance priorities, and facilitate inclusive input and decision-making processes. Ability to multitask, work independently, and organize efficiently. Ability to synthesize information and communicate effectively in written or verbal format with off-site colleagues, partners, groups of all sizes and individuals. Demonstrated computer literacy skills, using MS Office applications and other basic data systems including internet navigation. Ability to interact effectively with people from diverse backgrounds. Must be honest, dependable and able to meet deadlines. Self-motivated and able to work independently. Physical Requirements: Ability to sit most of the time with some bending and reaching. Ability to stand, walk, and bend periodically. Ability to engage in repetitive movement of wrists, hands, and fingers – typing and/or writing. Ability to work frequently at close visual range (i.e. preparing and analyzing data and figures, accounting, transcription, computer terminal, extensive reading). Ability to receive and respond to oral communication. Ability to exert up to 10 pounds of force to lift, carry, push, pull, or otherwise move objects. Work Environment: Work is generally performed remotely, typically in a home office environment; occasionally, work occurs in a business office environment where: Noise level is moderate to occasionally loud (examples: business office with computers and printers, light to moderate traffic, human voices). Standard equipment generally used includes: Smartphone/Telephone Personal Computer (monitor, keyboard, and mouse), Laptop, or Tablet Printer/Photocopy Machine Calculator Fax Machine May be required to operate a motor vehicle during the course of duties. PME is an equal opportunity employer. We prohibit discrimination and harassment against any applicant or employee based on any legally recognized basis, including, but not limited to: veteran status, uniformed servicemember status, race, color, religion, sex, sexual orientation, gender identity, age (40 and over), pregnancy, national origin or ancestry, citizenship status, physical or mental disability, genetic information (including testing and characteristics) or any other category protected by federal, state or local law.
La PorteIndiana Contract Mar 27, 2024 Healthcare Provide resources who are trusted members of the communities served and/or have an unusually close understanding of the communities to facilitate access to health care services, improve the quality and cultural competency of those services, and improve member health outcomes. Outreach Coordinator Resources work to increase health literacy, reduce costs of services, and improve care.  The overall approach for outreach workers is fluid and flexible based on identified quality and member outcome needs. The primary focus of the Outreach resources will be as follows:   Understand Member history and the physical, behavioral, and social factors that may be leading to less-than-ideal health outcomes or persistent gaps in care. Utilize a whole health approach when interacting with Members and caregivers. Working with Case Management to place outreach resources at point of care facilities to better facilitate member engagement and action. Facilitate real time gap closure initiatives including but not limited to immunizations, telehealth visits, A1c tests, lead tests, and blood pressure readings. Pivot priorities as necessary month to month based on HEDIS performance. Engage member in care coordination and case management as necessary. Educate member on health care benefits and services and monitor for over and/or underutilization
ChicagoIllinois Contract Mar 26, 2024 Other Area(s) PME is looking for a Healthcare Case Manager I (RN, LCSW, LMSW) experienced in Case Management working with complex medical and mental illness cases. Schedule M-F 8:30am-5:00pm CST. The Candidates MUST be within 30-minute driving time from the following locations: CHICAGO - Lincoln Park 60614 CHICAGO - West Garfield Park 60624 CHICAGO - Logan Square 60647 CHICAGO - Humboldt Park 60651  Summary Responsible for health care management and coordination of healthcare members Works with members to create and implement an integrated collaborative plan of care. Conducts assessment of member needs by collecting in-depth information from healthcare information system, the member, member’s family/caregiver, hospital staff, physicians, and other providers. Develops and implements a case management plan in collaboration with the member, care team. Familiarity with NCQA standards, state/federal regulations, and measurement techniques. In depth knowledge of CCA and/or other Case Management tools. Requirements Healthcare Case Management experience Active, unrestricted State RN license or Licensed Clinical Social Worker (LCSW or LMSW) in good standing 0-2 years of clinical experience with case management experience PME is an equal opportunity employer. We prohibit discrimination and harassment against any applicant or employee based on any legally recognized basis, including, but not limited to: veteran status, uniformed servicemember status, race, color, religion, sex, sexual orientation, gender identity, age (40 and over), pregnancy, national origin or ancestry, citizenship status, physical or mental disability, genetic information (including testing and characteristics) or any other category protected by federal, state or local law.  
Kokomo Contract Mar 26, 2024 Healthcare Provide resources who are trusted members of the communities served and/or have an unusually close understanding of the communities to facilitate access to health care services, improve the quality and cultural competency of those services, and improve member health outcomes. Outreach Coordinator Resources work to increase health literacy, reduce costs of services, and improve care.  The overall approach for outreach workers is fluid and flexible based on identified quality and member outcome needs. The primary focus of the Outreach resources will be as follows:   Understand Member history and the physical, behavioral, and social factors that may be leading to less-than-ideal health outcomes or persistent gaps in care. Utilize a whole health approach when interacting with Members and caregivers. Working with Case Management to place outreach resources at point of care facilities to better facilitate member engagement and action. Facilitate real time gap closure initiatives including but not limited to immunizations, telehealth visits, A1c tests, lead tests, and blood pressure readings. Pivot priorities as necessary month to month based on HEDIS performance. Engage member in care coordination and case management as necessary. Educate member on health care benefits and services and monitor for over and/or underutilization
KokomoIN Contract Mar 26, 2024 Healthcare Provide resources who are trusted members of the communities served and/or have an unusually close understanding of the communities to facilitate access to health care services, improve the quality and cultural competency of those services, and improve member health outcomes. Outreach Coordinator Resources work to increase health literacy, reduce costs of services, and improve care.  The overall approach for outreach workers is fluid and flexible based on identified quality and member outcome needs. The primary focus of the Outreach resources will be as follows:   Understand Member history and the physical, behavioral, and social factors that may be leading to less-than-ideal health outcomes or persistent gaps in care. Utilize a whole health approach when interacting with Members and caregivers. Working with Case Management to place outreach resources at point of care facilities to better facilitate member engagement and action. Facilitate real time gap closure initiatives including but not limited to immunizations, telehealth visits, A1c tests, lead tests, and blood pressure readings. Pivot priorities as necessary month to month based on HEDIS performance. Engage member in care coordination and case management as necessary. Educate member on health care benefits and services and monitor for over and/or underutilization
South BendIN Contract Mar 26, 2024 Healthcare Provide resources who are trusted members of the communities served and/or have an unusually close understanding of the communities to facilitate access to health care services, improve the quality and cultural competency of those services, and improve member health outcomes. Outreach Coordinator Resources work to increase health literacy, reduce costs of services, and improve care.  The overall approach for outreach workers is fluid and flexible based on identified quality and member outcome needs. The primary focus of the Outreach resources will be as follows:   Understand Member history and the physical, behavioral, and social factors that may be leading to less-than-ideal health outcomes or persistent gaps in care. Utilize a whole health approach when interacting with Members and caregivers. Working with Case Management to place outreach resources at point of care facilities to better facilitate member engagement and action. Facilitate real time gap closure initiatives including but not limited to immunizations, telehealth visits, A1c tests, lead tests, and blood pressure readings. Pivot priorities as necessary month to month based on HEDIS performance. Engage member in care coordination and case management as necessary. Educate member on health care benefits and services and monitor for over and/or underutilization
IndianapolisIN Contract To Hire Mar 25, 2024 Information Technology Duties and responsibilities included: • Tests complex API, web-based applications that reference database back-end systems. • Creates and maintains automated test cases, executes test suites, reviews and diagnoses reported bugs, and ensures overall system quality prior to a customer release. • Designs, develops, maintains, and troubleshoots automated suites of tests through continuous integration for value added feedback. • Works with the engineering teams to derive testing requirements throughout the development cycle. • Reproduces, debugs, and isolates problems and verify fixes. • Works closely with software developers to create software artifacts including test plans, test cases, test procedures and test reports. • Works cross functional areas with internal partner engineering teams in a disciplined agile environment. • Estimates own testing tasks and works productively with minimum supervision while showing excellent team attitude. • Represents team leadership and provides technical guidance and training to junior test personnel. • Participates in performance testing. Required qualifications. • BS degree in Computer Science or equivalent • Must have an understanding and ability to develop code in Java. Strong experience in API testing from SOAP, RESTful is required. • Strong experience with XML, Databases and SQL. • Must have strong analytical and problem-solving skills as well as the ability to analyze complex problems in large systems. • Experience with Test processes, open-source test frameworks, test design strategies, writing test cases, and automating tests in Java with frameworks like JUnit/TestNG, Selenium, JMeter and Appium is preferred. • Experience with Jenkins or other continuous integration systems. Experience with tools & applications such as JIRA, Confluence, Bitbucket, Git and Artifactory/Maven. • Experience with Health IT systems with Electronic Data Interface (EDI) processing • Knowledge of Medicare policies, programs, systems, and data. • Experience with 270/271 transactions and/or other X12 data formats • Prefer 5+ years of preferably in either a Software Development Engineer or (SDET) Software Development Engineer in Test role. • Experience with healthcare data, specifically Medicare/Medicaid • SAFe certification 40 hour work week, Mon-Fri. May require some after-hour & weekend support for release implementations. Hours will be 1st shift, starting between 7am-9am. After hour support may be needed for release implementations and/or quarterly releases, one to two times per month. Requires BA/BS degree or technical institute training; 2-4 year's experience, or any combination of education and experience, which would provide an equivalent background. This role requires the hired candidate to go through public clearance. A minimum of 3 years of stay in the U.S. within the last 5 years is a must to be eligible to qualify for public trust clearance sponsorship.
Contract Mar 25, 2024 Information Technology Primary duties may include, but are not limited to: Develops relationships with the business to better understand business requirements. Analyzes and classifies complex change request and identifies and documents possible enhancements. Participates in developing application scope and objectives and preparing functional and/or technical specifications. Aids graphic designers and other web team members to better understand and apply the right marketing focused content. Codes and maintains complex components of information systems. Develops and performs system testing and fixes defects identified during testing and re-executes unit tests to validate results. Participates in integrating activities with other IT departments for successful implementation and support of project efforts. Provides on call support and monitors the system. Facilitates small group design sessions or code reviews and participates in vendor evaluation. Requires BA/BS degree or technical institute training and 1 or more years; experience on one platform, or any combination of education and experience, which would provide an equivalent background. Multi database, multi language or multi business application is preferred. Required experience with Medicare Part B. Responsible for programming and coding of IT Healthcare software. Possesses skills in programming, data processing, and database management for health care systems. Experience in CMS / Healthcare / MAC applications with strong mainframe programming skills in languages like COBOL, JCL, CICS, DB2, IMS. Mon-Fri, 8:00a-5:00p Eastern is preferred. Can work anywhere in the USA - 100% remote.  
BuffaloNew York Contract Mar 20, 2024 Other Area(s) PME is seeking an RN Care Manager to conduct UAS Assessments to support care management. The position will be a field position in Upstate NY Buffalo.  Schedule will be M-F 8:30AM-5PM. ***MUST be UAS Certified and bilingual (Korean, Chinese, Mandarin, Spanish or Bengali). Essential Functions/Responsibilities: UAS Certified RN licensed in the state of NY. Conduct face to face assessments of members’ functional status, medical, behavioral, psychosocial and community resource needs. Provides the Interdisciplinary Care Team (ICT) with assessment information and acts as facilitator to ensure that members’ needs are met. Develop an ICP/PCSP based on members’ clinical, behavioral, and social needs that addresses barriers to care. Competently assesses members’ health status and ensures that member is receiving all necessary medical and supportive services. Manage care transitions through effective and timely communication necessary for member care and discharge planning. Clarifies SWH plan medical benefits, policies and procedures for members, providers and community-based agencies. Maintain a comprehensive working knowledge of community resources, payer requirements, and network services for target population. Required Education: Bachelor's Degree (a combination of experience and education will be considered in lieu of degree). Required Licensure/Certification: NY State RN License in good standing.PME is seeking an RN Care Manager to conduct UAS Assessments to support care management. The position will be a field position in Upstate NY Buffalo.  Schedule will be M-F 8:30AM-5PM. ***MUST be UAS Certified and bilingual (Korean, Chinese, Mandarin, Spanish or Bengali). Essential Functions/Responsibilities: UAS Certified RN licensed in the state of NY. Conduct face to face assessments of members’ functional status, medical, behavioral, psychosocial and community resource needs. Provides the Interdisciplinary Care Team (ICT) with assessment information and acts as facilitator to ensure that members’ needs are met. Develop an ICP/PCSP based on members’ clinical, behavioral, and social needs that addresses barriers to care. Competently assesses members’ health status and ensures that member is receiving all necessary medical and supportive services. Manage care transitions through effective and timely communication necessary for member care and discharge planning. Clarifies SWH plan medical benefits, policies and procedures for members, providers and community-based agencies. Maintain a comprehensive working knowledge of community resources, payer requirements, and network services for target population. Required Education: Bachelor's Degree (a combination of experience and education will be considered in lieu of degree). Required Licensure/Certification: NY State RN License in good standing.
Indiana Contract Mar 20, 2024 Other Area(s) Position Purpose: Schedule appointments, gather medical histories and updated member and provider information in support of member outreach and claims reimbursement. Responsibilities: • Assist members with scheduling office visits with primary care provider. • Retrieves charts from electronic medical record systems and compile medical records to send to other parties for coding. • Requests medical records by making outbound phone calls to provider groups. • Completes supplemental medical records requests using Excel files. • Assist with providing updated member and provider information to vendors. • Directs medical record requests to the responsible party. • Resolves outstanding vendor pends within a timely manner by updating member and provider demographics and working with chart load issues. • Ensure follow up on member appointments or other tasks designated. • Assist with ad hoc requests. Education/Experience: High school diploma or equivalent. 0-2+ years of customer service or medical office experience. Experience with preserved medical record retrieval systems preferred. Billing or coding experience preferred. Beginner level Excel skills.  
Contract Mar 20, 2024 Other Area(s) A Medical RN Care Manager II is needed to meet HBR targets and member enrollment. Fully remote M-F 8AM - 5PM. MUST reside in the state of Indiana. Cold call outreach to members,  Completion of member multiple enrollment and follow-up assessments,  Creation of member care plans Input documentation into multiple computer systems Daily collaboration with CM/UM/Pharmacy peers to meet member needs Checking eligibility in FSSA system,  Research claim encounter and Hospital systems to obtain member health history Maintain Case Load 50 Daily outreach 20-40 calls daily Monthly Quality Audit score 90% Education/Experience:  Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred.  2+ years of clinical nursing experience in a clinical, acute care, or community setting and 1+ years of case management experience in a managed care setting.  Knowledge of utilization management principles and healthcare managed care.  Experience with medical decision support tools (i.e. Interqual, NCCN) and government sponsored managed care programs. Licenses/Certifications: Current state’s RN license.  
LafayetteIndiana Contract Mar 18, 2024 Healthcare Provide resources who are trusted members of the communities served and/or have an unusually close understanding of the communities to facilitate access to health care services, improve the quality and cultural competency of those services, and improve member health outcomes. Outreach Coordinator Resources work to increase health literacy, reduce costs of services, and improve care.  The overall approach for outreach workers is fluid and flexible based on identified quality and member outcome needs. The primary focus of the Outreach resources will be as follows:   Understand Member history and the physical, behavioral, and social factors that may be leading to less-than-ideal health outcomes or persistent gaps in care. Utilize a whole health approach when interacting with Members and caregivers. Working with Case Management to place outreach resources at point of care facilities to better facilitate member engagement and action. Facilitate real time gap closure initiatives including but not limited to immunizations, telehealth visits, A1c tests, lead tests, and blood pressure readings. Pivot priorities as necessary month to month based on HEDIS performance. Engage member in care coordination and case management as necessary. Educate member on health care benefits and services and monitor for over and/or underutilization
Contract Mar 15, 2024 Information Technology We are seeking an experienced, Solution/Technical Architect for providing architecture support to information systems leadership, business stakeholders, and internal teams regarding cloud, technology, architecture governance, and MMIS modernization solutions. The Solution/Technical Architect will be directly responsible for the customers success in MMIS modernization near term and long term initiatives, this role is an individual contributor role involved in all architecture activities related to cloud modernization, transforming on-prem applications to cloud, and MITA 3.0 framework implementation. The role involves creating policy and standards, researching cloud solutions for business problems, providing subject matter experience to MMIS modernization and Systems Integration. Candidate will need to have a deep understanding of cloud technologies, architecture patterns, and best practices coupled with the ability to research and analyze complex business problems to recommend appropriate solutions that align with near term modernization goals. The selected candidate will be working in a dynamic team environment, and creativity, agility, and the ability to work under minimal supervision are key to success in this role. Responsibilities: Collaborate with information systems directors, leadership, product managers, and business owners to translate business problems into cloud based modern technical solutions. Strong ability to be customer focused, able to understand customers vision and translate them to solutions. Demonstrated ability to back decisions with research and the “why,” and articulate options, with benefits and challenges for solution recommendations. Strong ability to see the 'big picture' and able to implement strategies that align for success in meeting customer goals. Responsible to orchestrate Systems Integration across various MMIS modernization initiatives. Responsible for designing, describing, and managing solutions for MMIS modernization. Responsible to, develop, review, and champion architecture framework strategies, policies, guidelines, standards that govern the Enterprise as a whole. Work with a diverse range of projects, including application development, integration, data management, and security solutions. Qualifications: Expert in cloud-based technologies, such as AWS, Azure, or Google Cloud Platform. Expert with MMIS-specific module implementation, Systems integration experience, enterprise architecture, solution architecture, and State and Local government implementation. 5 to 7+ years of experience in cloud solutions development focusing on architecture, preferably in the healthcare or public sector. Expert with healthcare industry standards (e.g., HIPAA, ICD-10, HL7, FHIR, X12). Experience transitioning organizations implementing MITA modernization, modularization, and interoperability principles. Expert in architecture skills in one or more areas: Solution architecture, Cloud architecture, Technology architecture. Experience in Enterprise cloud applications focused on Data Analytics, Data Warehousing, and Data Lakes. Strong experience in implementing Role Based Access Controls (RBAC) using Identity and Access Management. Strong experience implementing synchronous, asynchronous interoperability patterns including SOAP, REST, JSON, APIs, and Micro-Services architecture. Experience in Enterprise Architecture implementing policies, guidelines, and standards. Excellent written and oral business communication skills. Strong interpersonal skills.
Contract Mar 14, 2024 Information Technology Job description: Under general direction, develops and maintains data processing applications which meet customer business needs.  Codes, tests, and implements computer programs in developmental and maintenance modes.  Defines system requirements and priorities with customers and ensures that daily needs are met. Develops system and programming specifications.  Designs data processing solutions based on business need and technical considerations.  Researches and resolves application production problems. Monitors application performance and performs run time improvement functions.  Prepares system documentation.  Qualifications:   •    College degree preferred or equivalent work experience. •    Minimum 3-5 years of development experience o    Experience in healthcare industry •    Work related experience in these technologies required: C, Linux, SQL, and Oracle. •    Work related experience in these technologies helpful: scripting tools (K-Shell, C-Shell, Linux, Oracle, TFS, Visual Studio, GitHub) •    Experience in Requirements Analysis, Code/Test/Implementation •    Experience with Systems Development Life Cycle methodology •    Strong analytical skills •    Strong communication skills PME is an equal opportunity employer. We prohibit discrimination and harassment against any applicant or employee based on any legally recognized basis, including, but not limited to: veteran status, uniformed servicemember status, race, color, religion, sex, sexual orientation, gender identity, age (40 and over), pregnancy, national origin or ancestry, citizenship status, physical or mental disability, genetic information (including testing and characteristics) or any other category protected by federal, state or local law.
La PorteIndiana Contract Mar 14, 2024 Healthcare Provide resources who are trusted members of the communities served and/or have an unusually close understanding of the communities to facilitate access to health care services, improve the quality and cultural competency of those services, and improve member health outcomes. Outreach Coordinator Resources work to increase health literacy, reduce costs of services, and improve care.  The overall approach for outreach workers is fluid and flexible based on identified quality and member outcome needs. The primary focus of the Outreach resources will be as follows:   Understand Member history and the physical, behavioral, and social factors that may be leading to less-than-ideal health outcomes or persistent gaps in care. Utilize a whole health approach when interacting with Members and caregivers. Working with Case Management to place outreach resources at point of care facilities to better facilitate member engagement and action. Facilitate real time gap closure initiatives including but not limited to immunizations, telehealth visits, A1c tests, lead tests, and blood pressure readings. Pivot priorities as necessary month to month based on HEDIS performance. Engage member in care coordination and case management as necessary. Educate member on health care benefits and services and monitor for over and/or underutilization
Contract Mar 13, 2024 Administrative Contracts and Procurement Specialist – Responsibilities Working closely with the workstream manager to develop solicitation content, including RFP language, technical and financial evaluation criteria, as well as functional and non-functional requirements. Assisting in the development and creation of supplemental procurement/contracting materials to procure services addressing procurement scope ranging from information technology, healthcare service delivery, and administrative functions. Collaborating with multiple teams, particularly with IT teams, to help write contractual requirements and ensure compliance with state and federal procurement regulations. Responsible for developing and executing procurement strategies that align with client’s goals. Continually looking for new ways to improve and streamline the procurement process.   Procurement and Contracts Specialist – Mandatory Qualifications 5-7+ Year of Procurement or Contract experience, government experience preferred Experience developing RFPs, RFQs and other similar contracting vehicles for large system acquisitions for government agencies (above and beyond task orders, Indefinite Delivery and Indefinite Quantity or Master Service agreements, etc.) Proficient in MS Word, Outlook, and Excel Excellent writing skills (ability to take multiple requirements, condense, and improve wording while maintaining intent) Experience putting together a large document utilizing multiple sources Strong interpersonal skills Preferred: Possess JD and experience with Software/Technology Contracting  Experience with Medicaid and HHS eligibility and case management systems Familiarity with software development lifecycle Familiarity with consulting services Experience writing user manuals Experience writing security and privacy policy documents Experience interacting with government or corporate contracting officers Experience with Managed Care Contracting
Fort WayneIndiana Contract Mar 12, 2024 Call Center Intermediate knowledge of training processes, such as adult learning theories and instructional design principles. Effective facilitation skills, such as ability to facilitate open discussion in a less structured environment. Effective class preparation skills. Ability to coordinate cross state tasks and to interact with employees in all areas of the project. Ability to analyze effectiveness of training and to independently implement, with guidance from the training supervisor, appropriate solutions without compromising instructional design and adult learning theory. Ability to coach others and provide performance feedback (e.g. trainees, agents, etc.) Travel within the State of Indiana REQUIREMENTS: Education: Some college with 1 plus years experience in facilitation/trainer role or HS diploma or GED and 2 plus years experience with Indiana Eligibility Public Assistance Programs. Must be able to travel 20% - 40% within the State of Indiana Extensive knowledge of Policy and Guidelines in relation to Indiana Eligibility Public Assistance Programs (TANF, Medicaid, SNAP Preferred Experience working in IEDSS Bachelor’s Degree Coaching or training experience Training Certification Excellent communication & presentation skills PME is an equal opportunity employer. We prohibit discrimination and harassment against any applicant or employee based on any legally recognized basis, including, but not limited to: veteran status, uniformed servicemember status, race, color, religion, sex, sexual orientation, gender identity, age (40 and over), pregnancy, national origin or ancestry, citizenship status, physical or mental disability, genetic information (including testing and characteristics) or any other category protected by federal, state or local law.
MarionIndiana Contract Mar 8, 2024 Administrative Pay Rate:  $14.50hr (Weekly Pay) Hours: Monday thru Friday 9am-6pm Duties and Responsibilities  The responsibilities are outlined as follows and no intended to be all inclusive: Enters alphabetic, numeric, or symbolic data from electronic images utilizing the Captiva Input Accel software application to capture the appropriate data including repairing any rejected characters as a result of the OCR function. Routes electronic data to next work flow process when completed or in the case of undefined documents or documents that are not able to be indexed, may need to route electronic image to next work flow process. Responds to inquiries regarding the status of data capture, rejected character repair, or quality assurance phases of the data capture process. Follows proper procedures, rules, and processes for data capture and quality assurance of the data as outlined in the procedures manual. Utilizes appropriate and compliant safeguards to reasonably prevent the use or disclosure of confidential and protected information including Protected Health Information (PHI) and Personally Identifiable Information (PII) and reports any concerns to the Document Center Operations Manager.  must be a team player and required to assist the entire team in meeting the Key Performance Indicators (KPI) requirements. 90% of documents are scanned, indexed and entered into the database on the same business day of receipt by Doc Center if received prior to 7:15 pm. 90% of documents are scanned, indexed and entered into the database by Noon of the following business day if received after 7:15 pm. 100% of documents are scanned within two business days of receipt by Doc Center. Job Requirements To perform this job successfully, an individual must be able to perform each essential duty satisfactorily, with or without accommodations.  The requirements listed below are representative of the knowledge, skill, and/or ability required.      Education/Experience Previous work experience helpful. High School Diploma or equivalent required.      Essential Functions: Knowledge, Skills, Abilities Proficient computer skills Ability to track work and document routinely Manual dexterity with proficient hand-eye coordination Excellent verbal communication skills Regular and timely attendance on the job  
Contract Mar 8, 2024 Other Area(s) Functional Responsibility: Create and/or revise web-based training modules, job aids, facilitator guides, and other job-related resources, working with subject matter experts, Learning Consultants, and other Technical Consultants. Education and General Experience: Bachelor's degree and 2-4 years' experience in adult education. Experience desired: using web page development, Microsoft Office 2010, Captivate, Adobe Flash Professional, Adobe Photoshop, Adobe Premiere Pro, SnagIt, Microsoft SharePoint, and video-audio recording using readily available computer technology.
Contract Mar 8, 2024 Call Center **Remote Opportunity** Responsibilities: Manage small call center staff, including hiring, scheduling, addressing employee issues, and implementing and maintaining standard operating procedures for a 24/7/365 crisis intervention line. Engage callers to assess and de-escalate crises in the least restrictive manner to ensure caller safety over the phone Develop and assist in the implementation of crisis safety plans As appropriate, provide emotional support, motivational interviewing, assessment or referral, linkage, and consultation with other mental health service providers . Elevate crisis calls based on standard operating procedures while also using clinical acumen and risk assessment skills. Report to assigned supervisor and actively seek consultation whenever necessary or requested by supervisor Build rapport with team members that fosters a team culture promoting values and vision Actively participate in quality improvement activities to promote continual growth and improvement in quality of services provided Continually engage in training and professional learning to build skills and collaborate with other team members Completion of required documentation within established timeframes. Use of an Electronic Client Record, and additional call management software. Maintain any applicable licensure and/or certification requirements. Maintain intake notes, agency resource records, and documentation Maintain familiarity with, and adhere to, program policies and procedures Maintain confidentiality of privileged information and adhere to client privacy laws Document all critical incidents and utilize all agency procedures for proper documentation and record keeping Stay up to date on all required trainings Experience: Education: Bachelor’s Degree in psychology, counseling, social work or related field is required.  At least 1-2 years of clinical and/or crisis intervention experience is preferred. Knowledge of or experience in crisis response and/or suicide prevention program delivery. Computer Skills: Proficiency in Microsoft Office 365; Proficiency in Internet Explorer, Outlook/Exchange; Windows operating systems
Contract Mar 8, 2024 Call Center **Remote Opportunity** Responsibilities: Manage small call center staff, including hiring, scheduling, addressing employee issues, and implementing and maintaining standard operating procedures for a 24/7/365 crisis intervention line. Engage callers to assess and de-escalate crises in the least restrictive manner to ensure caller safety over the phone Develop and assist in the implementation of crisis safety plans As appropriate, provide emotional support, motivational interviewing, assessment or referral, linkage, and consultation with other mental health service providers . Elevate crisis calls based on standard operating procedures while also using clinical acumen and risk assessment skills. Report to assigned supervisor and actively seek consultation whenever necessary or requested by supervisor Build rapport with team members that fosters a team culture promoting values and vision Actively participate in quality improvement activities to promote continual growth and improvement in quality of services provided Continually engage in training and professional learning to build skills and collaborate with other team members Completion of required documentation within established timeframes. Use of an Electronic Client Record, and additional call management software. Maintain any applicable licensure and/or certification requirements. Maintain intake notes, agency resource records, and documentation Maintain familiarity with, and adhere to, program policies and procedures Maintain confidentiality of privileged information and adhere to client privacy laws Document all critical incidents and utilize all agency procedures for proper documentation and record keeping Stay up to date on all required trainings Experience: Education: Bachelor’s Degree in psychology, counseling, social work or related field is required. Licensed Mental Health Counselor (LMHC) preferred At least 1-2 years of clinical and/or crisis intervention experience is preferred. Knowledge of or experience in crisis response and/or suicide prevention program delivery. Computer Skills: Proficiency in Microsoft Office 365; Proficiency in Internet Explorer, Outlook/Exchange; Windows operating systems
LafayetteIndiana Contract Mar 7, 2024 Healthcare Provide resources who are trusted members of the communities served and/or have an unusually close understanding of the communities to facilitate access to health care services, improve the quality and cultural competency of those services, and improve member health outcomes. Outreach Coordinator Resources work to increase health literacy, reduce costs of services, and improve care.  The overall approach for outreach workers is fluid and flexible based on identified quality and member outcome needs. The primary focus of the Outreach resources will be as follows:   Understand Member history and the physical, behavioral, and social factors that may be leading to less-than-ideal health outcomes or persistent gaps in care. Utilize a whole health approach when interacting with Members and caregivers. Working with Case Management to place outreach resources at point of care facilities to better facilitate member engagement and action. Facilitate real time gap closure initiatives including but not limited to immunizations, telehealth visits, A1c tests, lead tests, and blood pressure readings. Pivot priorities as necessary month to month based on HEDIS performance. Engage member in care coordination and case management as necessary. Educate member on health care benefits and services and monitor for over and/or underutilization
ClarksvilleIndiana Contract Mar 7, 2024 Healthcare Provide resources who are trusted members of the communities served and/or have an unusually close understanding of the communities to facilitate access to health care services, improve the quality and cultural competency of those services, and improve member health outcomes. Outreach Coordinator Resources work to increase health literacy, reduce costs of services, and improve care.  The overall approach for outreach workers is fluid and flexible based on identified quality and member outcome needs. The primary focus of the Outreach resources will be as follows:   Understand Member history and the physical, behavioral, and social factors that may be leading to less-than-ideal health outcomes or persistent gaps in care. Utilize a whole health approach when interacting with Members and caregivers. Working with Case Management to place outreach resources at point of care facilities to better facilitate member engagement and action. Facilitate real time gap closure initiatives including but not limited to immunizations, telehealth visits, A1c tests, lead tests, and blood pressure readings. Pivot priorities as necessary month to month based on HEDIS performance. Engage member in care coordination and case management as necessary. Educate member on health care benefits and services and monitor for over and/or underutilization
IndianapolisIndiana Direct Hire Mar 1, 2024 Administrative Professional Management Enterprises, inc. is hiring a Sourcing Specialist in Indianapolis, Indiana. The Sourcing Specialist is responsible for all sourcing and pre-screening of candidates for various clients. Your primary responsibility will be to support the Recruiting Department in their hiring processes for candidates locally and remotely throughout our client base.  Location: 9245 North Meridian Street, Ste. 210 Indianapolis, Indiana 46260 Schedule:  Full-Time, Monday – Friday, 8am – 5pm Responsibilities: • Collaborate with recruiters to understand job requirements and develop targeted sourcing strategies. • Utilize various sourcing channels, including job boards, social media, professional networks, and industry-specific platforms, to identify and engage potential candidates. • Conduct thorough candidate screenings to ensure alignment with job requirements. • Build and maintain a pipeline of qualified candidates for current and future job openings. • Actively participate in the development and implementation of innovative sourcing methods to enhance recruitment efficiency. • Provide regular updates and reports on sourcing activities, candidate pipelines, and market trends. Qualifications: • Proven experience as a Sourcing Specialist or similar role in a recruiting environment. • Hands-on experience with Applicant Tracking Systems (ATSs) and other Human Resources Management software • Strong understanding of different industries and job markets. • Excellent communication and interpersonal skills. • Ability to work independently and collaboratively in a fast-paced environment. Good time-management skills with the ability to handle various open positions simultaneously. • Exceptional organizational and time management skills. • Sourcing experience within the Healthcare and Call Center industry is preferred Education and Experience: Bachelors in Human Resources Management or relevant field 1+ years of full cycle recruitment or sourcing experience. 1+ years of experience developing and executing sourcing methodologies to include: market mapping, recruitment strategies and Boolean searches 1+ years of Applicant Tracking System experience, (i.e. Bullhorn, Indeed, ZipRecruiter) 1+ years of experience conducting competency/behavioral based interviews PME is an equal opportunity employer. We prohibit discrimination and harassment against any applicant or employee based on any legally recognized basis, including, but not limited to: veteran status, uniformed servicemember status, race, color, religion, sex, sexual orientation, gender identity, age (40 and over), pregnancy, national origin or ancestry, citizenship status, physical or mental disability, genetic information (including testing and characteristics) or any other category protected by federal, state or local law.  
ColumbiaSouth Carolina Contract Feb 26, 2024 Other Area(s) Seeking an RN with Managed Care and Utilization Management experience to review and evaluate medical or behavioral eligibility regarding benefits and clinical criteria. This position is remote, but requires the candidate to reside in the state of S.C. The scheduled is M-F 8:30am-5:00pm. Essential Duties: Review and evaluate medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and established clinical criteria to service requests or provides health management program interventions.   Utilizes clinical proficiency, claims knowledge/analysis, and comprehensive knowledge of healthcare continuum to assess, plan, implement, coordinate, monitor, and evaluate medical necessity, options, and services required to support members in managing their health, chronic illness, or acute illness.  Utilizes available resources to promote quality, cost effective outcomes. Preferred Skills and Abilities: Working knowledge of Microsoft Office Excel, Access, or other spreadsheet/database software. Thorough knowledge/understanding of claims/coding analysis, requirements, and processes. Required Experience: 3 years recent clinical in defined specialty area. Specialty areas include: oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review/case management/clinical/or combination; 2 of the 4 years must be clinical. Required Education: Associate Degree - Nursing, OR, Graduate of Accredited School of Nursing. PME is an equal opportunity employer. We prohibit discrimination and harassment against any applicant or employee based on any legally recognized basis, including, but not limited to: veteran status, uniformed servicemember status, race, color, religion, sex, sexual orientation, gender identity, age (40 and over), pregnancy, national origin or ancestry, citizenship status, physical or mental disability, genetic information (including testing and characteristics) or any other category protected by federal, state or local law.  
MarionIndiana Contract Feb 23, 2024 Administrative Job Summary Data Capture Specialist is responsible for the accurate capture of the alphabetic, numeric, or symbolic data from electronic images and/or source documents according to the custom developed software application including repair of incorrect data resulting from OCR process (optical character recognition results). Pay Rate: $14.50hr (Weekly Pay) Work Schedule Monday (9:00 am – 6:00 pm) Tuesday (9:30 am – 5:30 pm) Wednesday – Friday (9:00 am – 5:30 pm) Duties and Responsibilities  The responsibilities of the Data Capture Specialist are outlined as follows and no intended to be all inclusive: Enters alphabetic, numeric, or symbolic data from electronic images utilizing the Captiva Input Accel software application to capture the appropriate data including repairing any rejected characters as a result of the OCR function. Routes electronic data to next work flow process when completed or in the case of undefined documents or documents that are not able to be indexed, may need to route electronic image to next work flow process. Responds to inquiries regarding the status of data capture, rejected character repair, or quality assurance phases of the data capture process. Follows proper procedures, rules, and processes for data capture and quality assurance of the data as outlined in the procedures manual. Utilizes appropriate and compliant safeguards to reasonably prevent the use or disclosure of confidential and protected information including Protected Health Information (PHI) and Personally Identifiable Information (PII) and reports any concerns to the Document Center Operations Manager.  Data Capture Specialist must be a team player and required to assist the entire team in meeting the Key Performance Indicators (KPI) requirements. 90% of documents are scanned, indexed and entered into the database on the same business day of receipt by Doc Center if received prior to 7:15 pm. 90% of documents are scanned, indexed and entered into the database by Noon of the following business day if received after 7:15 pm. 100% of documents are scanned within two business days of receipt by Doc Center. Competencies To perform the job successfully, an individual should demonstrate the following competencies:         Quality:  Demonstrates accuracy and thoroughness; looks for ways to improve and promote quality; applies feedback to improve performance; monitors own work to ensure quality. Must meet standards of quality that are required to meet the service levels and performance standards outlined in the SLA/KPI’s.         Quantity:  Meets productivity standards; completes work in timely manner; strives to increase productivity; works accurately and efficiently.         Dependability:  Follows instructions; responds to management direction; takes responsibility for own actions; maintains the production schedule requirements; commits to extended hours of work when necessary to reach daily production schedules and meets the daily service levels and performance standards; completes tasks on time or notifies supervisor of any potential delays or inabilities to meet the daily service levels and performance standards (SLA/KPI) requirements.           Adaptability:  Adapts to changes in the work environment; manages competing demands; changes approach or method as directed by supervisor; exhibits ability to deal with change or unexpected events. Job Requirements To perform this job successfully, an individual must be able to perform each essential duty satisfactorily, with or without accommodations.  The requirements listed below are representative of the knowledge, skill, and/or ability required.      Education/Experience Previous work experience helpful. High School Diploma or equivalent required.      Essential Functions: Knowledge, Skills, Abilities Proficient computer skills Ability to track work and document routinely Manual dexterity with proficient hand-eye coordination Excellent verbal communication skills Regular and timely attendance on the job Physical Demands and Work Environment The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.   While performing the duties of this job, the employee is frequently required to sit, talk, hear, and use hands to write, type, handle, or feel. Specific vision abilities required by this job include close vision. Specific lifting requirements include ability to lift and move trays weighing up to 20 pounds. The noise level in the work environment is usually moderate and the work environment includes proximity to many individuals like a public environment. PME is an equal opportunity employer. We prohibit discrimination and harassment against any applicant or employee based on any legally recognized basis, including, but not limited to: veteran status, uniformed servicemember status, race, color, religion, sex, sexual orientation, gender identity, age (40 and over), pregnancy, national origin or ancestry, citizenship status, physical or mental disability, genetic information (including testing and characteristics) or any other category protected by federal, state or local law.