Professional Management Enterprises, Inc.

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Contract Apr 15, 2024 Other Area(s) Seeking RN, LPN, LMSW or MSW with LTSS experience to be responsible for health care management and coordination of members to achieve optimal clinical, financial and quality of life outcomes. MUST reside in the Lynchburg, VA area. Schedule M-F 8:00am-5:00pm. Day to Day Responsibilities: Will be responsible for performing case management activities according to the contractual requirements and in alignment with NCQA requirements. This will include potential home visits to complete assessments as well as completion of telephonic assessments, completion of integrated care plans, and conducting interdisciplinary care team meetings. In addition, conducting needed telephonic follow-up, education, and care coordination for assigned members. Must Have Skills: • Must have a valid driver’s license and reliable vehicle for field visits • Excellent communication skills, with an ability to communicate effectively with members with chronic conditions, developmental disabilities, etc. • Strong technical skills (utilizing multiple programs at the same time) along with competency in Microsoft applications (Outlook, Teams, Excel, etc.) • Strong organizational and interpersonal skills Required Years of Experience: One year of experience working directly with individuals who meet the Cardinal Care Priority Population (Medicaid) criteria. Required Licensure / Education: Must have Bachelor’s degree in a health or human services field, LMHP, RN/LPN, QMHP, LMSW, LBSW, MSW or BSW  
Contract To Hire Apr 15, 2024 Information Technology Provides ongoing support of business, including ongoing data analysis, data quality testing, enhancement of metadata, etc. Reviews SQL code and provides turning suggestions. Provides DBMS technical configuration and troubleshooting. Provides user management and DBMS security support. 24x7 production and non-production DBA on-call support. Requires BA/BS in Computer Science or Information Systems or related field; 3 or more years of information systems experience; or any combination of education and experience, which would provide an equivalent background. Requires general business knowledge, general technical knowledge and knowledge of database administration techniques. Excellent written, oral and interpersonal communication skills required. Experience in utilizing DBMS system management tools and the ability to implement new DBMS features and functionality. ***Must be able to obtain a U.S. Federal Position of Trust clearance designation. *** Responsibilities • Responsible for the maintenance of production, test and development databases. • Brings solid understanding of database administration. • Supports development team from a database design and development perspective. • Responsible for database administration or engineering activities, ensure optimal performance on PostgreSQL environments.? • Responsible for the installation, maintenance, configuration, and integrity of PostgreSQL architecture.? • Performance tuning of the queries. • Provide support to the application developers, including, but not limited to data refresh, SQL and PL/pgSQL performance tuning and best practice recommendations. • Conduct code reviews with application developers. • Ensure the long-term requirements of systems operations and administration are included in the overall database systems planning of the organization.? • Perform many related database functions across one or more teams, including designing, implementing, and maintaining new databases, backup/recovery and configuration management. Required Qualifications • Bachelor’s degree • 3+ years of experience as a DBA / developer for complex and high-volume data warehouse projects.? • AWS certification • Strong PL/PGSQL or PL/SQL experience is a plus.? • Experience in PostgresSQL, AWS RDS Aurora PostgreSQL.? • Hands-on experience with Postgres database administration, performance tuning and production support in a high volume, customer-facing apps/environment.? • Data modeling experience • Experience working in Agile/ Scrum programs with multi-disciplinary development teams • Excellent written, verbal, and interpersonal communication skills • Manages time extremely well, can quickly sense when issues need to be addressed • Strong attention to detail and focus on task completion. Preferred Qualifications • Experience with health IT systems with Electronic Data Interface (EDI) processing • Experience with 270/271 transactions and/or other X12 data formats • Experience with healthcare data, specifically Medicare/Medicaid • 5+ years of experience as a DBA / developer for complex and high-volume data warehouse projects. 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 Apr 15, 2024 Other Area(s) Researches the substance of complex appeal or retrospective review requests including pre-pay and post-payment review appeal requests. Provides thorough clinical review or benefit analysis to determine if the requested services meet medical necessity guidelines. Documents decisions within mandated timeframes and in compliance with applicable regulations or standards. Schedule is M-F 8:00am – 5:00pm. Skills: Working knowledge of word processing software. Working knowledge of managed care and various forms of health care delivery systems. Strong clinical experience to include home health, rehabilitation, and/or broad medical surgical experience. Knowledge of specific criteria/protocol sets and the use of the same. Administrative Law Judge (ALJ) process. Statistical principles. National Committee for Quality Assurance (NCAG). Utilization Review Accreditation Commission (URAC). South Carolina Department of Insurance (SCDOI). US DOL and Health Insurance Portability/Accountability Act (HIPAA) standards/regulations. Knowledge of claims systems. Education: Associate Degree - Nursing or Graduate of Accredited School of Nursing. Required Work Experience: 2 years clinical experience plus 1 year utilization/medical review, quality assurance, or home health, OR, 3 years clinical. Required License and Certificate: An active, unrestricted RN license in the state of SC, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC). Preferred Education: Bachelor's degree- Nursing. Preferred Work Experience: 3 years-utilization/medical review, quality assurance, or home health, plus 5 years clinical.
Contract Apr 12, 2024 Other Area(s) Seeking RN, LPN, LMSW or MSW to be responsible for health care management and coordination of members to achieve optimal clinical, financial and quality of life outcomes. MUST reside in the Tidewater Region of VIRGINIA. Schedule M-F 8:00am-5:00pm. Day to Day Responsibilities: Will be responsible for performing case management activities according to the contractual requirements and in alignment with NCQA requirements. This will include potential home visits to complete assessments as well as completion of telephonic assessments, completion of integrated care plans, and conducting interdisciplinary care team meetings. In addition, conducting needed telephonic follow-up, education, and care coordination for assigned members. Must Have Skills: • Must have a valid driver’s license and reliable vehicle for field visits • Excellent communication skills, with an ability to communicate effectively with members with chronic conditions, developmental disabilities, etc. • Strong technical skills (utilizing multiple programs at the same time) along with competency in Microsoft applications (Outlook, Teams, Excel, etc.) • Strong organizational and interpersonal skills Required Years of Experience: One year of experience working directly with individuals who meet the Cardinal Care Priority Population (Medicaid) criteria. Required Licensure / Education: Must have Bachelor’s degree in a health or human services field, LMHP, RN/LPN, QMHP, LMSW, LBSW, MSW or BSW  
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.
Contract Apr 11, 2024 Call Center Job Description: Responsible for providing immediate assistance and support to individuals experiencing emotional, psychological, or behavioral crises. Duties involve assessing clients' needs, de-escalating tense situations, offering counseling and guidance, coordinating referrals to appropriate resources or services, and documenting interactions. Job Details 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. •    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. •    Other tasks as assigned.  Part-time and Full-time positions available Shift and schedule     Three shifts are available: 6 a.m. to 2 p.m. 2p.m. to 10 p.m. 10 p.m. to 6 a.m. Sunday through Saturday This position is Remote. 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. Education     Minimum of a bachelor's degree in psychology, social work, counseling, or a related field 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 Apr 8, 2024 Other Area(s) Seeking a Grievance and Appeals Coordinator to enter appeals into the tracking system within contractual time limits. Responsible for reviewing and resolving member and provider complaints. The position is fully remote but MUST reside in INDIANA. The scheduled is Monday to Friday 8:00am-4:30pm. Summary:  Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members. Job Responsibilities: Gather, analyze and report verbal and written member and provider complaints, grievances and appeals Prepare response letters for member and provider complaints, grievances and appeals Maintain files on individual appeals and grievances May coordinate the Grievance and Appeals Committee Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information Assist with HEDIS production functions including data entry, calls to provider’s offices, and claims research. Manage large volumes of documents including copying, faxing and scanning incoming mail Education/Experience:  High school diploma or equivalent.  Associate’s degree preferred. 0-2 years of experience.  
Contract Apr 5, 2024 Industrial RESPONSIBILITIES:   • Perform preventive maintenance as needed. • Complete assigned repair work as required. • Notify appropriate personnel on any visible major problems. • Keep work orders up to date. • Order parts and maintain garage stock room. • Keep area of assignment clean and orderly. • Assist in unloading the supply truck and loading old tires, empty oil drums etc. • Periodically complete training for new procedures and skills needed to maintain state owed commissions.   DUTIES:   • Perform the following repairs or preventative maintenance work on any of the following: 3-prong accessories, antennas, camera systems, deck lights, flashlight systems, fuses, light bars, mirror lights, motorcycle and trailer wiring, computer docking station and radio equipment. • Maintain various logs. • Use diagnostic equipment to trouble-shoot and find problems in the commission. • Test drive commission to ensure it is in working order. • Perform building custodian duties as required by the Division or District Commander. • Perform other duties as required.   ESSENTIAL FUNCTIONS AND JOB REQUIREMENTS   • Must be a high school graduate or possess GED certificate. • Must have a valid Indiana driver's license. • Ability to lift and move heavy automotive objects. • Ability to communicate and follow instructions. • Ability to distinguish and determine colors and sounds. • Ability to communicate effectively, both verbally and in writing. • Ability to work in close and confined areas. • Ability to maintain confidentiality. • Must be able to diagnose problems on the commissions. • Must be able to operate any of the assigned tools and equipment and use automotive shop manuals. • Must be able to complete any of the assigned repair jobs to include mechanical, electrical, hydraulic and computer. • Must be able to use diagnostic testing equipment to troubleshoot and find problems.
Contract Apr 5, 2024 Other Area(s) Seeking a Registered Nurse with current in-state license, with Utilization review or quality management experience. This position is fully remote. Work schedule is Mon-Fri, 8:00am-5:00pm. Must have at least 3 years’ experience in a clinical setting. InterQual experience desired. Must have basic PC skills, beginner knowledge of Microsoft Word and Excel.  
Contract Apr 4, 2024 Healthcare MUST LIVE IN INDIANA 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 under utilization Requirements: Community Outreach Experience preferred CHW Certification and/or CNA/HHA  preferred Home Visits Driver’s License required High School Diploma/GED required
Contract Apr 4, 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 under utilization Requirements: Community Outreach Experience preferred CHW Certification and/or CNA/HHA  preferred Home Visits Driver’s License required High School Diploma/GED required
Contract Apr 4, 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 under utilization Requirements: Community Outreach Experience preferred CHW Certification and/or CNA/HHA  preferred Home Visits Driver’s License required High School Diploma/GED required
Contract Apr 4, 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
Contract Apr 4, 2024 Other Area(s) Looking for a Healthcare Case Manager III. Must be Bilingual (English/Korean) and have MLTC, UAS Assessment and NY Medicaid policy experience. Must have an RN license in the State of NY. This position is fully remote, but the candidate must reside in the NYC Tristate area. The work schedule is M-F, 8:30am-5pm EST. Summary: Works with members, providers, and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. Completes clinical assessments of members per regulated timelines and determines who may qualify for case management based on clinical judgment, changes in member's health or psychosocial wellness, and triggers from the assessment. Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member’s needs and goals. Maintains ongoing member case load for regular outreach and management. Required Education | Experience: Bachelor’s degree in Nursing or Master’s degree in Social Work. 5-7 years in case management, disease management, managed care or medical or behavioral health settings. Bilingual in any language Active, unrestricted State Registered Licensed RN/LMSW/LCSW- Licensed in the State of NY in good standing.  
Contract Apr 4, 2024 Administrative Shift: (M-F), 8am-5pm Processes applications submitted by institutional providers seeking to enroll in the Medicare Part A program. Primary duties may include but are not limited to: Validates the accuracy of data submitted utilizing various electronic databases. Ensures accurate entry of data into CMS' national database for all CMS providers and suppliers. Processes initial applications, changes of information for existing providers, and processes electronic funds transfers. Calculates capitalization requirements for Home Health Agencies. Reviews sales agreements and bill of sale for change of ownership agreements. Reviews the agreement between CMS and the FQHC as well as the Health Resources and Services Administration grant for Federal Qualified Health Centers. Determines and then forwards recommendations to CMS and state agencies as to whether the application should be approved or denied. Maintains an understanding of the CMS directives and follows all processes and procedures in order to maintain the integrity of the program. May participate in special projects. Requirements: Requires a H.S. diploma; or any combination of education and experience, which would provide an equivalent background. Associate's degree preferred. 1-3 years experience in customer service or credentialing preferred. Medicare experience preferred.
Contract Apr 4, 2024 Other Area(s) Looking for a Healthcare Case Manager III. Must be Bilingual (Chinese, Cantonese or Mandarin) and have MLTC, UAS Assessment and NY Medicaid policy experience. Must have a NY license. The work schedule is M-F, 8:30am-5pm EST. Summary: Works with members, providers, and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. Completes clinical assessments of members per regulated timelines and determines who may qualify for case management based on clinical judgment, changes in member's health or psychosocial wellness, and triggers from the assessment. Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member’s needs and goals. Conducts telephonic, face-to-face, or home visits as required. Maintains ongoing member case load for regular outreach and management. Assesses barriers to care, provides care coordination and assistance to member to address concerns.   Required Education | Experience: Bachelor’s degree in Nursing or Master’s degree in Social Work. 5-7 years in case management, disease management, managed care or medical or behavioral health settings. Bilingual in any language Active, unrestricted State Registered Licensed RN/LMSW/LCSW- Licensed in the State of NY in good standing.
Contract Apr 4, 2024 Administrative Responsible for providing basic clerical activities in support of a department. Primary duties may include, but are not limited to: Makes and receives phone calls to exchange information to accomplish tasks. Routinely files work, reports, etc. in case files and designated areas. Sorts, labels, alphabetizes documents/files, etc. for others to execute work effort. Extracts, sorts, preps, batches and routes documents within the company as needed. Operates camera/scanner and retrieves previously scanned information as needed. Copies incoming and outgoing correspondence. Requires a High School diploma or GED; up to 1 year of related work experience; or any combination of education and experience, which would provide an equivalent background. Basic analytical, communication and vocational skills and ability to operate basic equipment required.
Contract Apr 3, 2024 Administrative **Remote Position - 12-month contract with possibility of extension** The Direct Specialist is responsible for ensuring that all new hire contractors and subcontractor personnel meet the requirements of the C2 Level of Trust Clearance, aligned with DoD directives -Provide systems access to our client's Government associates, subcontractors, and government staff with appropriate on-line applications via security passwords and access levels to ensure system integrity - Responsible for the coordination, administration and auditing of systems access activities -Granting access to EQIP system through data entry -Troubleshooting system application issues by speaking with applicants and answering questions Responsibilities Include: Data Entry (Medical exp./terminology very helpful) Gaining appropriate clearance levels for new hires Provide systems access to associates, subcontractors, and government staff with appropriate on-line applications via security passwords and access levels to ensure system integrity Experience with using MS Office (Outlook, Excel, Access, Word, etc…). Ability to work out of multiple databases. Act independently to work with associates needing to complete the Electronic Questionnaires for Investigations Processing (e-QIP) process Qualifications: Bachelor’s Degree preferred 3+ years of administrative experience. Ability to demonstrate strong attention to detail 1+ year customer service experience US Citizenship required Expertise in customer service, written and verbal skills. Requirements: Bachelor degree preferred Must be able to pass a Federal background check and drug screen Must meet all requirements to receive C2 Level of Trust Experience utilizing Microsoft Office Suite applications Comfortable with high levels of data entry 2 or more years of experience in Healthcare/Medical field
Contract Apr 3, 2024 Other Area(s) Seeking an Accounts Payables Specialist. Must reside within reasonable driving distance of Long Beach, CA. This position will require you to be in the office Tuesday and Thursday and work remotely Monday, Wednesday, and Fridays. The work schedule is 8:30am-5:30pm PST. Summary: Responsible for processing check runs, ACH payment runs, processing invoices, PO matching invoices, researching statements. To process, input and maintain AP. Close month end, reconcile, and allocate expenses. Essential Functions: Complete AP invoice tickets. Identifying proper GL account number and accounting period including performing research of incoming invoices. Issue A/P checks. Research and verify old outstanding invoices as requested. Process expense reports. Knowledge/Skills/Abilities: Excellent verbal and written communication skills Required Education: High School graduate. Required Experience: Minimum 0-2 years’ experience in accounts payable and/or receivable.  
Contract Apr 2, 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. 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 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.    
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.  
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.  
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.
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 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.
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  
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.  
Contract Feb 8, 2024 Other Area(s) PME is seeking an RN Care Manager to conduct UAS Assessments to support care management. Candidates will be assigned a minimum of 13-15 cases per week. The position will be a field position, and candidates must be local to Brooklyn and Queens in New York as field visits will be completed within these territories. ***MUST be UAS Certified and bilingual (Bengali or Spanish). 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. Skills/Aptitudes: Strong professional level of knowledge and comprehensive clinical assessment skills in the adult population and chronic disease management Ability to work independently and maintain flexibly in fast paced environment. Excellent communication skills Self-starter with high level of accountability and responsibility for outcome of care Strong computer skills: competent in Microsoft Office Products (Outlook, Word, Excel) Ability to analyze data and use it to improve care delivery. 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 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 Dec 13, 2023 Call Center A customer service representative, or CSR, will act as a liaison, provide services information, and resolve any emerging problems that our customer accounts might face with accuracy and efficiency. The best CSRs are genuinely excited to help customers. They’re patient, empathetic, and passionately communicative. They love to talk. Customer service representatives can put themselves in their customers’ shoes and advocate for them when necessary. Problem-solving comes naturally to customer care specialists. They are confident at troubleshooting and investigate if they don’t have enough information to resolve customer complaints. The target is to ensure excellent service standards, respond efficiently to customer inquiries and maintain high customer satisfaction. Location: Remote (Must reside in Indiana) Hours:  8 hour shift between 8am-8pm Pay: $14hr (Paid Weekly) Each representative will be a part of an incentive program that pays out weekly (in addition to base pay) Must be able to work a fixed 8 hr shift between 8am-8pm Candidate must reside in Indiana All equipment will be provided to each representative to work remotely Requirements: Manage large amounts of outgoing calls to welcome members Identify and assess customers’ needs to achieve satisfaction Build sustainable relationships and trust with customer accounts through open and interactive communication Provide accurate, valid, and complete information by using the right methods/tools Meet personal/customer service team targets and call handling quotas Handle customer complaints, provide appropriate solutions and alternatives within the time limits; follow up to ensure resolution. Keep records of customer interactions, process customer accounts and file documents Follow communication procedures, guidelines, and policies Take the extra mile to engage customers Ability to create and maintain a professional remote work environment/area 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.