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Contract Jun 18, 2024 Healthcare Job Title: Clinical Administrative Coordinator Location:  Indiana (Remote) Pay:  $24hr (Paid Weekly) Benefits: 8 paid holidays; 80hrs of PTO (after 60 days of employment); Optional Medical, Dental, Vision Hours:  Ability to work any of our 8-hour shift schedules during normal business hours of 8:00am – 8:00pm EST, Monday – Friday. It may be necessary, given the business need, to work occasional overtime Primary Responsibilities: •    Manage administrative intake of members •    Work with hospitals, clinics, facilities and the clinical team to manage requests for services from members and/or providers •    Process incoming and outgoing referrals, and prior authorizations, including intake, notification and census roles •    Assist the clinical staff with setting up documents/triage cases for Clinical Coverage Review Required Qualifications: •    High School Diploma / GED •    Must be 18 years of age or older  •    2+ years of customer service experience •    Experience with Microsoft Word, Excel (create, edit, save documents and spreadsheets) and Outlook (email and calendar management) Preferred Qualifications: •    Experience working in a call center •    Clerical or administrative support background •    Bilingual fluency in English/Spanish •    Experience working in a hospital, physician’s office or medical clinic setting •    Experience working within the health care Industry and with health care insurance Remote Requirements: •    Ability to keep all company sensitive documents secure (if applicable) •    Required to have a dedicated work area established that is separated from other living areas and provides information privacy. •    Must live in a location that can receive high-speed internet connection or leverage an existing high-speed internet service. 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 Jun 18, 2024 Other Area(s) Program Specialist (Social Worker) to assist with non-medical aspects of the member’s care, including referrals to community resources. The work schedule is M-F 8:00am-5:00pm. This position is remote but MUST reside in INDIANA. Job Responsibilities:  Identify special needs members through a variety of sources.  Work with community outreach/member advocates to coordinate member care. Educate providers and community resources on program components and available support services. Development of plan specific literature and education materials. Describe the performance expectations/metrics for this individual and their team Education/Experience: Bachelor’s degree in Social Work, Behavioral Science or Equivalent Experience. Experience in a managed care environment preferred. 0-2 years of experience    
Contract Jun 18, 2024 Other Area(s) This position is hybrid and is on an office rotation. Requirement will be one week out of every 4 weeks, Monday through Friday and 1 weekend day out of every 5 weeks. Hours of work are 9:00 AM to 5:30 PM PST Los Angeles County. Responsibilities include triaging mail, scanning into the system and categorizing accordingly. Creating Grievance and Appeals cases with accuracy. Reviewing voicemails via phone system from providers and addressing accordingly. Knowledge/Skills/Abilities: Excellent verbal and written communication skills. Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA). Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers. Demonstrated adaptability and flexibility to changes and response to new ideas and approaches. Required Education:  High School Diploma or equivalent.  Required Experience: 2+ years of PC experience in a Windows environment. Experience using Microsoft Word. Filing experience preferred. Experience with customer service  
Contract Jun 17, 2024 Healthcare Job Title: (RN) Well Care Coordinator Location:  Remote (South Bend, Indiana) **Must be an Indiana Resident Hours: Monday - Friday 8am-5pm Pay:  $48hr weekly pay Travel Requirement: 25% - 50% 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). 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 To Hire Jun 17, 2024 Administrative Title: Mission Support Specialist Location:  Indianapolis, IN Hours: Monday - Friday 8am-5pm The duties and responsibilities shall include: Assist the Local Accountability Officer (LAO) with the full lifecycle management of all Personal Property by completing necessary training, acquiring an SAP property management role, and performing that role in accordance with pertinent CBP guidance.  Assist the federal employees in maintaining 100% accountability of all Personal Property by maintaining personnel files (CBP Form 259) for both accountable and administratively controlled property.  Assist the federal employees in the acquisition and disposal of personal property in accordance with published CBP guidance and policy.  Perform inventories twice each year for all OFAM personnel locations to maintain property accountability utilizing the current system of record (SAP).  Onboarding Support and maintain the OFAM Strategic Onboarding Initiative – by actively engaging in all activities relevant to new employee orientation, reception, integration, and in-processing by completing "Pre-Work" performance measures as well as serving as the ROM POC for delivering New Employee Orientation (NEO) for Federal Employees and Contractors. In “Hoteling” environments, provide access to CBP OnBoard (Seating Reservation System), and assign lockers.  Review new hires, separations, and transfers for all OFAM federal employees (currently the "EOD Report") and determine what, if any, actions are required, then implement and communicate those actions within each working group.   Provide direct support to OFAM and Enterprises Services personnel with Homeland Security Presidential Directive -12 (HSPD-12) Personal Identity Verification (PIV) issues; troubleshooting, maintenance, and PIV creation and issuance (at locations with card creation services).  Daily Operations include:  Greeting visiting OFAM employees, stakeholders, and business partners in each location; answer questions about local facility, grant temporary or permanent access to OFAM-controlled CBP facilities and space, as appropriate.  Provide in-person office coverage in support of normal day-to-day operations in assigned CBP locations.  Skills Required: Proficient communication skills. Effective interpersonal skills. Excellent organizational skills. Demonstrates ability to maintain confidential information. Demonstrates excellent judgment and decision-making skills. Ability to simultaneously handle multiple priorities. Maintains a high degree of professionalism. Microsoft Office (Word, Excel and Outlook). Able to lift up to 40lbs.  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 Jun 10, 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. Requirements: Community Outreach Experience preferred CHW Certification and/or CNA/HHA  preferred Home Visits Driver’s License required High School Diploma/GED required  
Direct Hire Jun 4, 2024 Other Area(s) Overview: The SLED (State, Local, and Education) Market Contract Specialist plays a pivotal role in managing contracts and agreements within the SLED sector. This role requires meticulous attention to detail, strong negotiation skills, and comprehensive knowledge of procurement regulations within the public sector. The primary objective is to facilitate the contract lifecycle, ensuring compliance, mitigating risks, and optimizing terms to achieve favorable outcomes for all parties involved. Responsibilities: Contract Management: Oversee the entire contract lifecycle, including drafting, negotiation, execution, and renewal, ensuring adherence to company policies and regulatory requirements. Bid and Proposal Development: Collaborate with sales and account management teams to develop competitive bids and proposals tailored to the unique needs and regulations of the SLED market. Compliance Assurance: Ensure all contracts and agreements comply with relevant laws, regulations, and procurement policies governing the SLED sector, including but not limited to FAR, DFARS, and state-specific regulations. Negotiation: Conduct negotiations with SLED agencies, vendors, and partners to optimize contract terms, pricing, and service level agreements while maintaining a positive relationship with stakeholders. Risk Management: Identify and mitigate potential contractual risks, such as legal, financial, and reputational risks, through thorough analysis and proactive measures. Relationship Building: Cultivate and maintain strong relationships with SLED agencies, vendors, partners, and internal stakeholders to facilitate smooth contract processes and foster collaboration. Documentation and Reporting: Maintain accurate records of all contracts, amendments, and related documents, and generate regular reports on contract status, performance, and compliance. Market Analysis: Stay informed about market trends, regulatory changes, and competitive landscapes within the SLED sector to provide strategic insights and support decision-making processes. Requirements: Bachelor’s degree in Business Administration, Finance, Legal Studies, or related field. Advanced degree or certification in Contract Management or Procurement is a plus. Proven experience (5+ years) in contract management, procurement, or related roles, preferably within the SLED market or public sector. In-depth knowledge of procurement regulations and procedures governing the SLED sector, including familiarity with FAR, DFARS, and state-specific regulations. Strong negotiation skills with the ability to effectively communicate and persuade stakeholders to reach mutually beneficial agreements. Excellent organizational skills and attention to detail, with the ability to manage multiple contracts and deadlines simultaneously. Proficiency in contract management software and Microsoft Office suite. Analytical mindset with the ability to identify and mitigate risks, solve problems, and make data-driven decisions. Exceptional interpersonal skills and the ability to build and maintain relationships with diverse stakeholders. Preferred Qualifications: Experience working with SLED agencies or educational institutions. Familiarity with government contracting processes and compliance requirements. Certification in Contract Management (e.g., CPCM, CFCM, CCCM) or related field. Knowledge of specific industry standards and best practices relevant to the SLED market (e.g., IT, healthcare, education). Experience with proposal development and responding to RFPs (Request for Proposals) or RFQs (Request for Quotes). This job description outlines the essential duties and qualifications required for the role of a SLED Market Contract Specialist. The position demands a combination of contract management expertise, regulatory knowledge, and interpersonal skills to navigate the complexities of the public sector procurement landscape effectively. 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.
Direct Hire Jun 4, 2024 Accounting POSITION TITLE: Accountant - Bursar Department DIVISION: Finance & Administration DEPARTMENT: Bursar CLASSIFICATION: Full-time; Exempt   POSITION DESCRIPTION OCCUPATIONAL SUMMARY   The Student Accounts Specialist reports to the CFO & Executive Vice President of Finance & Administration. The Student Accounts Specialist is responsible for daily administration of the University’s accounts receivable, and the accuracy of charges, credits, payments, and refunds entered in the billing system. The Student Accounts Specialist works closely with the Financial Aid Department & the Business office for the reconciliation of the aid applied to students’ accounts. The Student Accounts Specialist works closely and collaboratively with the university leadership to achieve a strategic, studentcentered approach to student accounts management.    This position does not supervise others.   ESSENTIAL JOB FUNCTIONS   Maintains and manages student financial accounts in compliance with federal and state regulations and audit compliance guidelines, including posting and disbursement of funds as appropriate.  Oversees disbursement policies and ensures adherence to the appropriate regulatory requirements associated with the disbursement of financial aid funds.  Oversees upgrades to the institution’s Comprehensive Academic Management Reporting Systems for student accounts. Oversees financial clearance for students to register. Prepares payment plans as needed and oversees related payment plans.  Directs invoices and collection of funds for student payment of tuition, books, and fees through government and external funding sources.  Manages the drawdown and reconciliation of financial aid funds. Create journal entries for recording deposits to the University accounts and monthly reconciliation of both Direct Loan, Pell, and State Aid.  Manages the return of financial aid funds and repayments for student withdrawals from the institution.  Devises innovative strategies, policies, and/or programs to attain goals and improve processes to reach department objectives. Regularly assesses program functions to assure compliance with operating rules, regulations, policies, and procedures; advises supervisor promptly of any problematic irregularities. Assures the management and integrity of all student account data in compliance with all applicable state and federal laws, rules, and regulations.  Oversees and maintains VA external funding, including billing and application to student accounts. Maintains VA documents under the guidance of US regulations.  Works with external audits to finance, financial aid and VA funds. ESSENTIAL JOB FUNCTIONS continued: Assist with other accounting and finance functions within the Business Office. Operates effectively within established budgetary guidelines and prepares required reports. Develops relationships and maintains effective communications with diverse groups, internal and external, in support of the institution’s mission. Represents institution at functions upon request. Serves on administrative committees as assigned. Performs other duties as required.   MINIMUM REQUIREMENTS Bachelor’s degree from an accredited college or university in business, accounting, or related field. Minimum 3-5 years of experience in financial management roles.  Strong understanding of accounting and financial management principles and practices. Strong leadership skills and the ability to coordinate with other student offices to support institutional goals. Demonstrated commitment to higher education.  Impeccable judgment and integrity.  Ability to manage confidential information.  Proficiency in the use of research, statistical analysis and information technologies. Ability to relate effectively with multiple constituencies.  Exceptional interpersonal and problem-solving. Exceptional knowledge of budget forecasting, preparation, and administration.    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 May 30, 2024 Healthcare Education Registered Nurse (RN) Degree Have a valid RN state license Experience Training in crisis management techniques, trauma-informed care, and relevant experience working with individuals in crisis situations. Strong interpersonal skills, empathy, and the ability to remain calm under pressure are essential for this role. Nurses in this role need strong clinical skills, communication abilities, and the ability to work independently. Job Description Responsible for providing telephonic triage, health advice, assessing symptoms, and determining the appropriate course of action, which may include recommending self-care, scheduling appointments, or advising on emergency care. Job Details Educate individuals on the importance of nutrition, safety, and overall good health. Provide knowledge and advice through our triage line. Engage callers to assess and de-escalate uneasy situations in the least restrictive manner to ensure caller safety over the phone. 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. Completion of required documentation within established timeframes. Use of an Electronic Client Record, and additional call management software. Maintain applicable licensure 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. Pay Negotiable Job Type Part-time and Full-time positions available Shift and schedule The three available full time shifts are: 7 a.m. to 3 p.m. 3 p.m. to 11 p.m. 11 p.m. to 3 a.m. Sunday through Saturday Work Setting Remote
Contract May 30, 2024 Healthcare Job Title: (RN) Well Care Coordinator Location:  Remote (Indiana) **Must be an Indiana Resident Hours: Monday - Friday 8am-5pm Pay:  $48hr weekly pay Travel Requirement: 25% - 50% 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). 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 May 24, 2024 Healthcare Bilingual candidates are encouraged to apply! Involved in the development, presentation and delivery of community outreach initiatives, activities and market strategies to support the Medicaid business and drive membership retention and growth. Must be an Indiana resident who resides in or near  County, Indiana, willing to travel throughout southern Indiana Conduct outreach activities for community members that are Aged, Blind, and Disabled Collaborate with local agencies and medical providers that serve the HCC and PathWays populations Educate and network with people of diverse backgrounds and cultures Report feedback from the field to further develop and enhance UHCCP programming Minimum Qualification, Training, and Experience: Five or more years of education and/or experience in the health services field, with a preference for a candidate who is a Certified Community Health Worker preferred Valid Indiana driver’s license required Reliable transportation required Travel up to 75% of the time within assigned territory Willing to work a flexible 40-hour week, including evenings and weekends Able to transport, lift, carry and set up promotional materials Smartphone capable of installing Microsoft Office, Zoom, SalesForce, Google Drive, Slack and others, as necessary Basic computer skills and knowledge of office programs, with the ability to learn new ones Experience in outreach and linking the community to local resources Able to deliver presentations and conduct meetings Flexible to adjust job responsibilities as the position evolves No fields configured
Contract May 23, 2024 Healthcare The Community Well Care Coordination Manager 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 Coordination Manager 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 Coordination Manager 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 Coordination Manager 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 or BSW 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  
Contract May 23, 2024 Healthcare Job Title: (RN) Well Care Coordinator Location:  Remote (Indiana) **Must be an Indiana Resident Hours: Monday - Friday 8am-5pm Pay:  $48hr weekly pay Travel Requirement: 25% - 50% 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). 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 May 7, 2024 Healthcare The Clinical Appeals Nurse is responsible for the completion of clinical appeals and state hearings from all states. Essential Functions: •    Responsible for the completion of clinical appeals and state hearings from all states •    Review and complete all provider clinical appeals within required timeframes. •    Review and complete member clinical appeals within required timeframes. •    Review all information necessary to prepare State Hearing packets. •    Communicate with state agencies and internal departments to prepare for State Hearings •    Attend assigned State Hearing and completed all required compliances. •    Complete required compliances for Administrative Hearing decisions •    Apply CareSource Medical Policy and Milliman guidelines when processing clinical appeals. •    Issue notification letters to providers and members. •    Issue administrative denials appropriately. •    Refer denials based on medical necessity to medical director. •    Maintain hardcopy documentation, Facets documentation and appeals database documentation at 90-95% accuracy rates. •    Conduct monthly, quarterly, and ad hoc appeals reporting. •    Collaborate with the Quality Improvement and Clinical Operations Team Lead to prepare all requests for Independent External Review •    Ensure compliance with regulatory and accrediting requirements. •    Perform any other job duties as requested. Education and Experience: •    RN License required. •    Associate degree or equivalent years of relevant experience required. •    Managed care, appeals, and Medicaid experience preferred. •    Utilization review experience is strongly preferred. •     Competencies, Knowledge, and Skills: •    Intermediate proficiency with Microsoft Office products and Facets •    Knowledge of NCQA, URAC, OAC, and MDCH regulations •    Strong written and oral communication skills •    Ability to work independently and within a team environment. •    Critical listening and thinking skills. •    Proper grammar usage •    Time management skills •    Proper phone etiquette •    Customer Service oriented •    Decision making/problem solving skills. •    Familiarity of healthcare field •    Knowledge of Medicaid •    Flexibility •    Change resiliency. Licensure and Certification: •    Current, unrestricted license as a Registered Nurse (RN) is required. •    MCG Certification is required or must be obtained within six (6) months of hire. Working Conditions: •    General office environment; may be required to sit or stand for extended periods of time.  
Contract Apr 30, 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: $14.85hr (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.
Contract Apr 11, 2024 Call Center Education A master's degree in counseling, clinical mental health counseling, psychology, social work, or related field. Experience Training in crisis management techniques, trauma-informed care, relevant experience working with individuals in crisis situations, substance abuse, depression, and anxiety. Strong interpersonal skills, empathy, and the ability to remain calm under pressure are essential for this role. Job Description Provide counseling and therapy services to individuals dealing with various mental health issues, emotional challenges, and life transitions. Conduct assessments, developing treatment plans, and implementing therapeutic interventions tailored to clients' needs and goals. Job Details Conduct assessments to understand clients' needs. Collaborate with other healthcare professionals, such as psychiatrists, psychologists, and social workers, to provide comprehensive care. Maintain accurate and confidential client records. Adhere to ethical guidelines and legal regulations. Participate in ongoing professional development to stay abreast of current research and best practices in the field. Support clients in improving their mental health and well-being. Facilitate positive life changes. Advocate for clients' rights and access to resources within the community. Engage callers to assess and de-escalate crises in the least restrictive manner to ensure caller safety over the phone. Assist in the implementation of crisis safety plans. As appropriate, provide emotional support, motivational interviewing, assessment or referral, linkage, and consultation with mental health service providers. Elevate crisis calls based on standard operating procedures while also using clinical acumen and risk assessment skills. 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. Other tasks as assigned.     Job Type Part-time and Full-time positions available Shift and schedule On call Work Setting Remote 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.