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Contract Nov 20, 2024 Other Area(s) Case Manager I (Social Worker or Healthcare Administrator) in the Sarasota, FL area. MUST have experience with reviewing for Medicaid/ MLTC members. The position is remote but may require in person to meet providers and the Team. The work scheduled is M-F, 8:00am – 5:00pm EST.
Day to Day Responsibilities:
Get services that you are eligible to receive
Set up appointments every 90 days or as needed
Arrange for transportation if member needs it
Identify any gaps in care or health care needs
Access resources to help you with special health care needs and assist your caregivers with day-to-day stress
Coordinate moving from one setting to another. This can include being discharged from the hospital
Assess eligibility for long-term care services and support
Connect with community resources
Find services from additional resources, including community and social services programs like physical therapy or "Meals on Wheels"
Arrange for services with a primary care provider (PCP), family members, caregivers and any other identified provider
Must Have Skills:
Good with computer systems and be able to learn a new system.
Experience with conducting clinical reviews and processed denials and partial denial determinations.
Reviewing for Medicaid/ MLTC members.
Must know Medicaid/ Medicare guidelines.
Custodial Care processes and workflows for any requests, verbal notifications for denials/partial denials to both member and provider, participation in IDTs, personal queue management and clinical reviews.
Required Years of Experience:
At least 1-2 years’ experience.
Required Licensure / Education: BA in related fields like Social Work, Health Administration. If licensed must be unrestricted and in good standing
Contract Nov 18, 2024 Healthcare The Community Well Care Coordinator must oversee the care coordination, complex case management functions for PathWays to Aging members who live in the community and who are not receiving Home and Community Based Services (HCBS) or designated as Nursing Facility Level of Care (NFLOC). The Care Coordinator must, at a minimum, be a registered nurse or similar medical professional with extensive experience in providing care coordination to members 60 years and older. This individual will work directly under the Health Services Directors to maintain the care coordination program. The individual will be responsible for overseeing care coordination teams, care plan development and care plan implementation. The Care Coordinator will be responsible for directing the activities of the care coordinators. These responsibilities extend to physical and behavioral health care services. This individual will work with the Heath Services Director, Service Coordinator Administrator, Medical Director, Provider and Member Services Managers, and with State staff as necessary, to communicate to providers and members. The Care Coordinator will provide input, as requested by the State, at State-level meetings.
Primary Responsibilities:
• Selects,develops, mentors and supports staff in designated department or region
• Develops clear goals and objectives for performance management and effectively communicates expectations, and holds the team accountable for results
• In order to meet the unique needs of our members, have an intimate understanding of the contractual requirements
• Identify, select, structure, and prioritize process improvement projects, ultimately implementing changes to meet program requirements
• Ensures standardized execution of workflow processes, including conducting performance audits, quality reviews, and compliance adherence
• Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care
• Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services
• Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members
• Advocate for patients and families as needed to ensure the patient’s needs and choices are fully represented and supported by the health care team
• Participates in training and coaching of direct reports as needed
• Conducts bi-annual field visits with direct reports to observe, provide areas of teaching, address issues and concerns and foster a good working relationship
• Collaborates across Optum and UHG and interacted with Medical Directors, Site Directors, Senior Leaders, Network, Marketing, Account Management, Quality, Product, and other stakeholders
Required Qualifications:
• Resident of Indiana
• BSN with equivalent experience
• Registered Nurse with an unrestricted License in Indiana
• Experience working within the community health setting in a health care role
• Experience or knowledge of Indiana Medicaid, Medicare, Long term care
• Experience coaching or mentoring staff
• Intermediate level of experience with Microsoft Word, with the ability to navigate a Windows environment
Preferred Qualifications:
• 3+ year of case management leadership experience within a healthcare industry
• Background in managed care
• Case Management experience
• Certified Case Manager (CCM)
• Experience / exposure with members receiving long term social supports
• Experience in utilization review, concurrent review and/or risk management
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. Contract Nov 18, 2024 Healthcare The Community Well Care Coordinator must oversee the care coordination, complex case management functions for PathWays to Aging members who live in the community and who are not receiving Home and Community Based Services (HCBS) or designated as Nursing Facility Level of Care (NFLOC). The Care Coordinator must, at a minimum, be a registered nurse or similar medical professional with extensive experience in providing care coordination to members 60 years and older. This individual will work directly under the Health Services Directors to maintain the care coordination program. The individual will be responsible for overseeing care coordination teams, care plan development and care plan implementation. The Care Coordinator will be responsible for directing the activities of the care coordinators. These responsibilities extend to physical and behavioral health care services. This individual will work with the Heath Services Director, Service Coordinator Administrator, Medical Director, Provider and Member Services Managers, and with State staff as necessary, to communicate to providers and members. The Care Coordinator will provide input, as requested by the State, at State-level meetings.
Primary Responsibilities:
• Selects,develops, mentors and supports staff in designated department or region
• Develops clear goals and objectives for performance management and effectively communicates expectations, and holds the team accountable for results
• In order to meet the unique needs of our members, have an intimate understanding of the contractual requirements
• Identify, select, structure, and prioritize process improvement projects, ultimately implementing changes to meet program requirements
• Ensures standardized execution of workflow processes, including conducting performance audits, quality reviews, and compliance adherence
• Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care
• Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services
• Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members
• Advocate for patients and families as needed to ensure the patient’s needs and choices are fully represented and supported by the health care team
• Participates in training and coaching of direct reports as needed
• Conducts bi-annual field visits with direct reports to observe, provide areas of teaching, address issues and concerns and foster a good working relationship
• Collaborates across Optum and UHG and interacted with Medical Directors, Site Directors, Senior Leaders, Network, Marketing, Account Management, Quality, Product, and other stakeholders
Required Qualifications:
• Resident of Indiana
• BSN with equivalent experience
• Registered Nurse with an unrestricted License in Indiana
• Experience working within the community health setting in a health care role
• Experience or knowledge of Indiana Medicaid, Medicare, Long term care
• Experience coaching or mentoring staff
• Intermediate level of experience with Microsoft Word, with the ability to navigate a Windows environment
Preferred Qualifications:
• 3+ year of case management leadership experience within a healthcare industry
• Background in managed care
• Case Management experience
• Certified Case Manager (CCM)
• Experience / exposure with members receiving long term social supports
• Experience in utilization review, concurrent review and/or risk management
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. Contract Nov 13, 2024 Other Area(s) Care Review Clinician I Nurse (LVN or RN) MUST be licensed in California.
Strong inpatient and outpatient medical and hospital analytical experience is needed. Excellent computer multi-tasking skills and good productivity is essential for this fast-paced role.
Strong computer skills, being able to toggle back and forth and use multiple databases.
Good analytical thought process is important to be successful in this role, this is a metric-based environment. Fully remote. The schedule is 8:00am-5:00pm or 8:30am-5:30pm or 9:00am-6:00pm PST.
Must Have Skills:
• Assesses inpatient services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.
• Analyzes clinical service requests from members or providers against evidence based clinical guidelines.
• Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.
• Conducts inpatient reviews to determine financial responsibility for members. May also perform prior authorization reviews and/or related duties as needed.
• Processes requests within required timelines.
• Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner.
• Requests additional information from members or providers in consistent and efficient manner.
• Makes appropriate referrals to other clinical programs.
• Adheres to UM policies and procedures.
Day to Day Responsibilities:
• Clearing discharges using UMK2 and EMR access
• Admission and continued stay reviews
• Processing NON PAR and Eligibility Reviews
• Completing reviews per Sharp/SCRIPPS/DIGNITY PROCESS
• Internal Reconsideration reviews
• Peer to Peer Follow Up
• Reconsideration Follow Up
• Processing denials and requesting letters
• Reviewing DOFR for financial responsibility
• Disenrollment for members that expire
• Following Hospital Assignment Grid / MD Coverage List
Required Years of Experience: 1 Year Med Surg
Required Licensure / Education: CA RN/LVN License
Direct Hire Nov 12, 2024 Administrative
POSITION TITLE:
Registrar
DIVISION:
Strategy, Innovation & Outreach
DEPARTMENT:
Registrar’s Office
CLASSIFICATION:
Full-time; Exempt
POSITION DESCRIPTION
OCCUPATIONAL SUMMARY
Reporting to the Associate Vice President of Enrollment Services, the Registrar provides leadership and oversight to all aspects of the Office of the Registrar. The Registrar plays a critical role in the University and Academic operations by effectively managing the maintenance and integrity of all students’ academic records, the approved curriculum, the creation and maintenance of course schedules, all areas of student registration. The registrar functions to achieve a strategic, student-centered approach to registrar activities and student records in support of the University’s mission and to integrate student registrar activities with the academic programs of the University.
This position does not supervise others.
ESSENTIAL JOB FUNCTIONS
Supervises the registration of continuing and incoming undergraduate students, transfer of credits, and degree evaluations;
The Registrar ensures the integrity, accuracy, and security of all academic records of current and former students, and facilitates an effective student registration process.
Partner with Admissions and Academic Advising to facilitate an efficient and timely process to move newly accepted students to register.
Manages an efficient transcript evaluation and processing.
Developing and maintaining degree audit system and certification of students for graduation/graduation clearance.
Maintains up-to-date course schedules, catalogs, final examination schedules.
Manages efficient use of classrooms.
Interprets and enforces academic policies and regulations of the University.
Must keep abreast of operational and reporting trends, regulations, and technology solutions for improving the efficiency and effectiveness of the Registrar's office.
Serves as of the officials responsible for FERPA compliance for the University.
Develop and maintain accurate curriculum management systems and published in the University Catalog.
Interprets and applies college policies and regulations related to Registrar services, including but not limited to explaining, implementing, interpreting, and enforcing academic policies of the University’s undergraduate and graduate faculties.
Maintains all official academic records of the University, and disseminates academic regulations and information to the University community.
Directs plans and coordinates registration procedures and graduation ceremonies, oversees the scheduling of courses, and provides data and reports.
Establishes and enforces registration policies and procedures for all University courses.
Works cooperatively with the Associate Vice President of Enrollment Services to ensure accurate student enrollment reporting to government agencies.
ESSENTIAL JOB FUNCTIONS continued:
Prepares required reports; analyzes date to determine student registration status, and to draw conclusions and/or make recommendations for process improvement.
Develops relationships and maintains effective communications with diverse groups, internal and external, in support of the institution’s mission.
Operates effectively within established budgetary guidelines.
Serves on administrative committees as assigned.
Performs other duties as assigned.
MINIMUM REQUIREMENTS
Master’s degree in student services, educational administration, educational leadership or a related degree, from an accredited college or university preferred.
Must have experience working with Student Information Systems, development of reports and regulations.
Minimum of two years of work experience at the assistant registrar level or higher preferred.
Proficiency in the use of research, statistical analysis and information technologies.
Impeccable judgment and integrity.
Ability to manage confidential information.
Ability to relate effectively with multiple constituencies.
Exceptional interpersonal, teambuilding and problem-solving skills.
Working knowledge of Microsoft Office and other standard computer software programs.
Excellent written and oral communication
The intent of this position description is to provide a representative level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a declaration of the total of the specific duties and responsibilities of any particular position. Employees may be directed to perform job-related tasks other than those specifically presented in this description.
Contract Nov 12, 2024 Healthcare Job Title: Clinical Case Manager
Location: Remote (Terre Haute, Indiana) **Must be an Indiana Resident
Hours: Monday - Friday 8am-5pm
Pay: $48 hourly | Weekly pay
Job Summary:
The Community Well Care Coordinator must oversee the care coordination, complex case management functions for PathWays to Aging members who live in the community and who are not receiving Home and Community Based Services (HCBS) or designated as Nursing Facility Level of Care (NFLOC).
Primary Responsibilities:
• Identify, select, structure, and prioritize process improvement projects, ultimately implementing changes to meet program requirements
• Ensures standardized execution of workflow processes, including conducting performance audits, quality reviews, and compliance adherence
• Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care
• Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services
• Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members
• Advocate for patients and families as needed to ensure the patient’s needs and choices are fully represented and supported by the health care team
• Collaborates across Optum and UHG and interacted with Medical Directors, Site Directors, Senior Leaders, Network, Marketing, Account Management, Quality, Product, and other stakeholders
Required Qualifications:
• Resident of Indiana
• BSN with equivalent experience
• Registered Nurse with an unrestricted License in Indiana
• Experience working within the community health setting in a health care role
• Experience or knowledge of Indiana Medicaid, Medicare, Long term care
• Intermediate level of experience with Microsoft Word, with the ability to navigate a Windows environment
Preferred Qualifications:
• 3+ year of case management leadership experience within a healthcare industry
• Background in managed care
• Case Management experience
• Certified Case Manager (CCM)
• Experience / exposure with members receiving long term social supports
• Experience in utilization review, concurrent review and/or risk management
Contract Nov 12, 2024 Healthcare The Community Well Care Coordinator must oversee the care coordination, complex case management functions for PathWays to Aging members who live in the community and who are not receiving Home and Community Based Services (HCBS) or designated as Nursing Facility Level of Care (NFLOC). The Care Coordinator must, at a minimum, be a registered nurse or similar medical professional with extensive experience in providing care coordination to members 60 years and older. This individual will work directly under the Health Services Directors to maintain the care coordination program. The individual will be responsible for overseeing care coordination teams, care plan development and care plan implementation. The Care Coordinator will be responsible for directing the activities of the care coordinators. These responsibilities extend to physical and behavioral health care services. This individual will work with the Heath Services Director, Service Coordinator Administrator, Medical Director, Provider and Member Services Managers, and with State staff as necessary, to communicate to providers and members. The Care Coordinator will provide input, as requested by the State, at State-level meetings.
Primary Responsibilities:
• Selects, manages, develops, mentors and supports staff in designated department or region
• Develops clear goals and objectives for performance management and effectively communicates expectations, and holds the team accountable for results
• In order to meet the unique needs of our members, have an intimate understanding of the contractual requirements
• Identify, select, structure, and prioritize process improvement projects, ultimately implementing changes to meet program requirements
• Ensures standardized execution of workflow processes, including conducting performance audits, quality reviews, and compliance adherence
• Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care
• Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services
• Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members
• Advocate for patients and families as needed to ensure the patient’s needs and choices are fully represented and supported by the health care team
• Participates in training and coaching of direct reports as needed
• Conducts bi-annual field visits with direct reports to observe, provide areas of teaching, address issues and concerns and foster a good working relationship
• Collaborates across Optum and UHG and interacted with Medical Directors, Site Directors, Senior Leaders, Network, Marketing, Account Management, Quality, Product, and other stakeholders
Required Qualifications:
• Resident of Indiana
• BSN with equivalent experience
• Registered Nurse with an unrestricted License in Indiana
• Experience working within the community health setting in a health care role
• Experience or knowledge of Indiana Medicaid, Medicare, Long term care
• Experience coaching or mentoring staff
• Intermediate level of experience with Microsoft Word, with the ability to navigate a Windows environment
Preferred Qualifications:
• 3+ year of case management leadership experience within a healthcare industry
• Background in managed care
• Case Management experience
• Certified Case Manager (CCM)
• Experience / exposure with members receiving long term social supports
• Experience in utilization review, concurrent review and/or risk management
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. Contract Nov 8, 2024 Administrative Job Summary
Data Capture Specialist is responsible for the accurate keying of information and scanning various documents.
Pay: 14.85/hour
Duties and Responsibilities
The responsibilities of the Data Capture Operator are outlined as follows and no intended to be all inclusive:
Accurately entering alphabetic and numeric data from electronic images with speed and accuracy utilizing software application to capture the appropriate data.
Reading, analyzing, and classifying documents based on certain assigned criteria.
Operating and maintaining scanning equipment, including processing documents through scanner and making appropriate adjustments to improve image capture.
Reviewing completed work and administering the company’s quality control procedures to ensure work is at or above required accuracy rates.
Assisting entire team in meeting daily and monthly KPIs and SLAs.
Following proper procedures, rules, and processes for data capture and quality assurance of data.
Utilizing appropriate and compliant safeguards to reasonably prevent the improper use or disclosure of confidential and protected information which may include Protected Health Information (PHI) and/or Personally Identifiable Information (PII) and reporting any concerns to manager.
Knowledge, Skills, and Abilities
High School Diploma or equivalent required.
Proficiency is MS Office (Word, Outlook, Teams, Sharepoint).
Excellent typing skills—touch, 10 key, 45 wpm
Ability to pass reference checks, drug screen, and background checks.
Work Schedule
Monday (9:00 am - 6:00 pm)
Wednesday (9:00 am - 5:30pm)
Friday (9:00 am - 5:30 pm)
Contract Oct 30, 2024 Industrial Position: Checker/Fulfillment
Department: Production
Position Reports to: Production Supervisor
Location: Fort Wayne, Indiana
Description: The position of Checker/Fulfillment requires attention to detail, good time management skills, and flexibility.
The position requires the ability to inspect the quality and sequential order of 100% of the products produced, the matching of plates to registrations and verification using a software program, to ensure the quality of the products are meeting the customer’s expectation. These tasks are to be performed in an effective and timely manner, in the comfort of a climate-controlled environment.
Responsibilities:
• Verify product quality of the license plate and vehicle registration document.
• Work effectively with a team to ensure timely delivery of orders.
• Prepare orders for shipment.
• Verification of license plates to registration documentation in terms of accuracy.
• Use of computer, scanners, and software to verify document/plate matching accuracy.
• Flexibility in duties and adjusting to meet customer demands.
• All other pertinent and assigned duties.
Requirements:
• Computer Experience
• Demonstrated evidence of successful teamwork
• Ability to perform Visual Color Discrimination: match or detect differences between colors, including shades of color and brightness on license plates.
• Professional and positive approach to communication
• Attention to detail and the ability to not allow oneself to be easily distracted
• Ability to multi-task
• Cross-training in other areas of the plant
• Previous production experience an asset
• Adhere to strict safety, quality, and production standards
• Required Personal protective equipment – safety toed shoes
• Work well under pressure
• Willing to work overtime as it is required
• Must be able to lift, up to 25 lbs
• Organized and dependable
• Be punctual and ready to work
• Must pass applicable background check, including but not limited to, drug and alcohol screening test.
• High School Diploma, or equivalent required.
Contract Oct 21, 2024 Call Center Job Description:
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. Contract Sep 26, 2024 Healthcare PME is actively seeking a CNA FT/PRN to assists with nursing programs as assigned. Performs a variety of tasks associated with the daily care and treatment of patients.
Job Responsibilities:
Administers and documents authorized medications and treatments per hospital policies and procedures.
Carries out or assists with physical care of patients including bathing, feeding, taking vital signs, heights, weights, and other activities of daily living as indicated.
Maintains current CPR and Bridge Building certifications.
Escorts patients to and from therapies, and other areas of the hospital for treatment and programming.
Escorts and/or drives patients to off-ground appointments and activities.
Observes patients’ physical condition and reports changes to the RN.
Appropriately and accurately reports pertinent information, both verbal and written.
Appropriately applies skills in psychosocial care of patients: Encourages patients and interacts with them to socialize and participate in activities and programming.
Job Requirements:
High school diploma or GED Equivalent
Successful completion of a Certified Nursing Assistant program
Basic computer skills are required.
Maintain current CPR.
Bridge Building certification.