Professional Management Enterprises, Inc.

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Contract Nov 8, 2024 Administrative Job Summary Data Capture Specialist is responsible for the accurate keying of information and scanning various documents.  Pay: 14.85/hour Duties and Responsibilities  The responsibilities of the Data Capture Operator are outlined as follows and no intended to be all inclusive: Accurately entering alphabetic and numeric data from electronic images with speed and accuracy utilizing software application to capture the appropriate data. Reading, analyzing, and classifying documents based on certain assigned criteria. Operating and maintaining scanning equipment, including processing documents through scanner and making appropriate adjustments to improve image capture. Reviewing completed work and administering the company’s quality control procedures to ensure work is at or above required accuracy rates. Assisting entire team in meeting daily and monthly KPIs and SLAs. Following proper procedures, rules, and processes for data capture and quality assurance of data. Utilizing appropriate and compliant safeguards to reasonably prevent the improper use or disclosure of confidential and protected information which may include Protected Health Information (PHI) and/or Personally Identifiable Information (PII) and reporting any concerns to manager. Knowledge, Skills, and Abilities High School Diploma or equivalent required. Proficiency is MS Office (Word, Outlook, Teams, Sharepoint). Excellent typing skills—touch, 10 key, 45 wpm Ability to pass reference checks, drug screen, and background checks. Work Schedule Monday (9:00 am - 6:00 pm) Wednesday (9:00 am - 5:30pm) Friday (9:00 am - 5:30 pm)
Contract Nov 8, 2024 Other Area(s) Job Title: Clinical Case Manager Location: Remote (Terre Haute, Indiana) **Must be an Indiana Resident Hours: Monday - Friday 8am-5pm Pay: $48 hourly | Weekly pay Job Summary: The Community Well Care Coordinator must oversee the care coordination, complex case management functions for PathWays to Aging members who live in the community and who are not receiving Home and Community Based Services (HCBS) or designated as Nursing Facility Level of Care (NFLOC). Primary Responsibilities: • Identify, select, structure, and prioritize process improvement projects, ultimately implementing changes to meet program requirements • Ensures standardized execution of workflow processes, including conducting performance audits, quality reviews, and compliance adherence • Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care • Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services • Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members • Advocate for patients and families as needed to ensure the patient’s needs and choices are fully represented and supported by the health care team • Collaborates across Optum and UHG and interacted with Medical Directors, Site Directors, Senior Leaders, Network, Marketing, Account Management, Quality, Product, and other stakeholders Required Qualifications: • Resident of Indiana • BSN with equivalent experience • Registered Nurse with an unrestricted License in Indiana • Experience working within the community health setting in a health care role • Experience or knowledge of Indiana Medicaid, Medicare, Long term care • Intermediate level of experience with Microsoft Word, with the ability to navigate a Windows environment Preferred Qualifications: • 3+ year of case management leadership experience within a healthcare industry • Background in managed care • Case Management experience • Certified Case Manager (CCM) • Experience / exposure with members receiving long term social supports • Experience in utilization review, concurrent review and/or risk management
Contract Nov 8, 2024 Healthcare The Community Well Care Coordinator must oversee the care coordination, complex case management functions for PathWays to Aging members who live in the community and who are not receiving Home and Community Based Services (HCBS) or designated as Nursing Facility Level of Care (NFLOC). The Care Coordinator must, at a minimum, be a registered nurse or similar medical professional with extensive experience in providing care coordination to members 60 years and older. This individual will work directly under the Health Services Directors to maintain the care coordination program. The individual will be responsible for overseeing care coordination teams, care plan development and care plan implementation. The Care Coordinator will be responsible for directing the activities of the care coordinators. These responsibilities extend to physical and behavioral health care services. This individual will work with the Heath Services Director, Service Coordinator Administrator, Medical Director, Provider and Member Services Managers, and with State staff as necessary, to communicate to providers and members. The Care Coordinator will provide input, as requested by the State, at State-level meetings. Primary Responsibilities: •    Selects, manages, develops, mentors and supports staff in designated department or region •    Develops clear goals and objectives for performance management and effectively communicates expectations, and holds the team accountable for results •    In order to meet the unique needs of our members, have an intimate understanding of the contractual requirements •    Identify, select, structure, and prioritize process improvement projects, ultimately implementing changes to meet program requirements •    Ensures standardized execution of workflow processes, including conducting performance audits, quality reviews, and compliance adherence •    Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care •    Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services •    Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members •    Advocate for patients and families as needed to ensure the patient’s needs and choices are fully represented and supported by the health care team •    Participates in training and coaching of direct reports as needed •    Conducts bi-annual field visits with direct reports to observe, provide areas of teaching, address issues and concerns and foster a good working relationship •    Collaborates across Optum and UHG and interacted with Medical Directors, Site Directors, Senior Leaders, Network, Marketing, Account Management, Quality, Product, and other stakeholders Required Qualifications: •    Resident of Indiana •    BSN with equivalent experience •    Registered Nurse with an unrestricted License in Indiana •    Experience working within the community health setting in a health care role •    Experience or knowledge of Indiana Medicaid, Medicare, Long term care •    Experience coaching or mentoring staff •    Intermediate level of experience with Microsoft Word, with the ability to navigate a Windows environment Preferred Qualifications: •    3+ year of case management leadership experience within a healthcare industry •    Background in managed care •    Case Management experience •    Certified Case Manager (CCM) •    Experience / exposure with members receiving long term social supports •    Experience in utilization review, concurrent review and/or risk management PME is an equal opportunity employer. We prohibit discrimination and harassment against any applicant or employee based on any legally recognized basis, including, but not limited to: veteran status, uniformed servicemember status, race, color, religion, sex, sexual orientation, gender identity, age (40 and over), pregnancy, national origin or ancestry, citizenship status, physical or mental disability, genetic information (including testing and characteristics) or any other category protected by federal, state or local law.
Contract Nov 7, 2024 Other Area(s) SUMMARY: Utilization Management RN to be responsible for collaborating with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources. MAJOR JOB DUTIES AND RESPONSIBILITIES: Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures. Applies clinical knowledge to work with facilities and providers for care coordination. Works with medical directors in interpreting appropriateness of care and accurate claims payment. May also manage appeals for services denied. Conducts pre-certification, inpatient, retrospective, out of network and appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts. Ensures member access to medical necessary, quality healthcare in a cost effective setting according to contract. Consult with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost effective care throughout the medical management process. Collaborates with providers to assess member's needs for early identification of and proactive planning for discharge planning. Facilitates member care transition through the healthcare continuum and refers treatment plans/plan of care to clinical reviewers as required and does not issue non-certifications. Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards. EDUCATION/EXPERIENCE: Requires an AS/BS in nursing; 2 years of acute care clinical experience; or any combination of education and experience, which would provide an equivalent background. Current unrestricted RN license in applicable state(s) required. Qualification Assessment Utilization Management and/or Milliman Care Guideline experience is preferred. Acute inpatient nursing experience is required. Must be comfortable working in a virtual environment with strong IT/computer skillset to include Excel, Microsoft Outlook, Microsoft Teams. Fast learner who can adapt to frequent process changes.
Direct Hire Nov 7, 2024 Administrative POSITION TITLE: Registrar DIVISION: Strategy, Innovation & Outreach DEPARTMENT: Registrar’s Office CLASSIFICATION: Full-time; Exempt       POSITION DESCRIPTION OCCUPATIONAL SUMMARY   Reporting to the Associate Vice President of Enrollment Services, the Registrar provides leadership and oversight to all aspects of the Office of the Registrar. The Registrar plays a critical role in the University and Academic operations by effectively managing the maintenance and integrity of all students’ academic records, the approved curriculum, the creation and maintenance of course schedules, all areas of student registration. The registrar functions to achieve a strategic, student-centered approach to registrar activities and student records in support of the University’s mission and to integrate student registrar activities with the academic programs of the University.   This position does not supervise others.  ESSENTIAL JOB FUNCTIONS Supervises the registration of continuing and incoming undergraduate students, transfer of  credits, and degree evaluations; The Registrar ensures the integrity, accuracy, and security of all academic records of current and former students, and facilitates an effective student registration process. Partner with Admissions and Academic Advising to facilitate an efficient and timely process to move newly accepted students to register. Manages an efficient transcript evaluation and processing. Developing and maintaining degree audit system and certification of students for graduation/graduation clearance. Maintains up-to-date course schedules, catalogs, final examination schedules. Manages efficient use of classrooms. Interprets and enforces academic policies and regulations of the University. Must keep abreast of operational and reporting trends, regulations, and technology solutions for  improving the efficiency and effectiveness of the Registrar's office. Serves as of the officials responsible for FERPA compliance for the University. Develop and maintain accurate curriculum management systems and published in the University Catalog. Interprets and applies college policies and regulations related to Registrar services, including but not limited to explaining, implementing, interpreting, and enforcing academic policies of the University’s undergraduate and graduate faculties. Maintains all official academic records of the University, and disseminates academic regulations and information to the University community. Directs plans and coordinates registration procedures and graduation ceremonies, oversees the scheduling of courses, and provides data and reports. Establishes and enforces registration policies and procedures for all University courses. Works cooperatively with the Associate Vice President of Enrollment Services to ensure accurate student enrollment reporting to government agencies.   ESSENTIAL JOB FUNCTIONS continued: Prepares required reports; analyzes date to determine student registration status, and to draw conclusions and/or make recommendations for process improvement. Develops relationships and maintains effective communications with diverse groups, internal and external, in support of the institution’s mission. Operates effectively within established budgetary guidelines. Serves on administrative committees as assigned. Performs other duties as assigned. MINIMUM REQUIREMENTS Master’s degree in student services, educational administration, educational leadership or a related degree, from an accredited college or university preferred. Must have experience working with Student Information Systems, development of reports and regulations. Minimum of two years of work experience at the assistant registrar level or higher preferred. Proficiency in the use of research, statistical analysis and information technologies. Impeccable judgment and integrity. Ability to manage confidential information. Ability to relate effectively with multiple constituencies. Exceptional interpersonal, teambuilding and problem-solving skills. Working knowledge of Microsoft Office and other standard computer software programs. Excellent written and oral communication   The intent of this position description is to provide a representative level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a declaration of the total of the specific duties and responsibilities of any particular position.  Employees may be directed to perform job-related tasks other than those specifically presented in this description.  
Contract Nov 6, 2024 Other Area(s) Care Review Processor II to assist the IP non-clinical team with processes requests, and information to ensure the delivery of high quality, cost-effective healthcare services. Fully Remote*** Must work PST Time Zone. Work schedule options are: Tues-Sat 8:30am–5:30pm or 8:30am-5:00pm PST Sunday-Thurs 8:30am–5:30pm or 8:30am-5:00pm PST Essential Functions: Generating faxes from the Clerk box to the Coordinator box. Assist with daily call outs to facilities to confirm if member is still in house or has been discharged. Assisting with verifying facility and IPA phone and fax numbers. Processing Custodial Care referrals. Required Education:  High School Diploma/GED  Required Experience:  2-4 years of experience in a Utilization Review Department in a Managed Care Environment. Previous Hospital or Healthcare clerical, audit or billing experience. Experience with Medical Terminology. PME is an equal opportunity employer. We prohibit discrimination and harassment against any applicant or employee based on any legally recognized basis, including, but not limited to: veteran status, uniformed servicemember status, race, color, religion, sex, sexual orientation, gender identity, age (40 and over), pregnancy, national origin or ancestry, citizenship status, physical or mental disability, genetic information (including testing and characteristics) or any other category protected by federal, state or local law.
Contract Nov 6, 2024 Healthcare The Community Well Care Coordinator must oversee the care coordination, complex case management functions for PathWays to Aging members who live in the community and who are not receiving Home and Community Based Services (HCBS) or designated as Nursing Facility Level of Care (NFLOC). The Care Coordinator must, at a minimum, be a registered nurse or similar medical professional with extensive experience in providing care coordination to members 60 years and older. This individual will work directly under the Health Services Directors to maintain the care coordination program. The individual will be responsible for overseeing care coordination teams, care plan development and care plan implementation. The Care Coordinator will be responsible for directing the activities of the care coordinators. These responsibilities extend to physical and behavioral health care services. This individual will work with the Heath Services Director, Service Coordinator Administrator, Medical Director, Provider and Member Services Managers, and with State staff as necessary, to communicate to providers and members. The Care Coordinator will provide input, as requested by the State, at State-level meetings. Primary Responsibilities: •    Selects,develops, mentors and supports staff in designated department or region •    Develops clear goals and objectives for performance management and effectively communicates expectations, and holds the team accountable for results •    In order to meet the unique needs of our members, have an intimate understanding of the contractual requirements •    Identify, select, structure, and prioritize process improvement projects, ultimately implementing changes to meet program requirements •    Ensures standardized execution of workflow processes, including conducting performance audits, quality reviews, and compliance adherence •    Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care •    Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services •    Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members •    Advocate for patients and families as needed to ensure the patient’s needs and choices are fully represented and supported by the health care team •    Participates in training and coaching of direct reports as needed •    Conducts bi-annual field visits with direct reports to observe, provide areas of teaching, address issues and concerns and foster a good working relationship •    Collaborates across Optum and UHG and interacted with Medical Directors, Site Directors, Senior Leaders, Network, Marketing, Account Management, Quality, Product, and other stakeholders Required Qualifications: •    Resident of Indiana •    BSN with equivalent experience •    Registered Nurse with an unrestricted License in Indiana •    Experience working within the community health setting in a health care role •    Experience or knowledge of Indiana Medicaid, Medicare, Long term care •    Experience coaching or mentoring staff •    Intermediate level of experience with Microsoft Word, with the ability to navigate a Windows environment Preferred Qualifications: •    3+ year of case management leadership experience within a healthcare industry •    Background in managed care •    Case Management experience •    Certified Case Manager (CCM) •    Experience / exposure with members receiving long term social supports •    Experience in utilization review, concurrent review and/or risk management PME is an equal opportunity employer. We prohibit discrimination and harassment against any applicant or employee based on any legally recognized basis, including, but not limited to: veteran status, uniformed servicemember status, race, color, religion, sex, sexual orientation, gender identity, age (40 and over), pregnancy, national origin or ancestry, citizenship status, physical or mental disability, genetic information (including testing and characteristics) or any other category protected by federal, state or local law.
Contract Nov 1, 2024 Other Area(s) Case Manager I (Social Worker or Healthcare Administrator) in the Miami-Dade, FL area. MUST have case management experience with LTC members. The position is remote but may require 1-2 service days in person to meet providers and the Team. The work scheduled is M-F, 8:30am – 5:00pm EST. Bilingual in English/Spanish. KNOWLEDGE/SKILLS/ABILITIES • Completes comprehensive assessments of members per regulated timelines. • Facilitates comprehensive waiver enrollment and disenrollment processes. • Develops and implements a case management plan, including a waiver service plan, in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals. • Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. • Promotes integration of services for members including behavioral health care and long-term services and supports, home and community to enhance the continuity of care for members. • Assesses for medical necessity and authorize all appropriate waiver services. • Evaluates covered benefits and advise appropriately regarding funding source. • Facilitates interdisciplinary care team meetings for approval or denial of services and informal ICT collaboration. • Assesses for barriers to care, provides care coordination and assistance to member to address psycho/social, financial, and medical obstacles concerns. • Identifies critical incidents and develops prevention plans to assure member’s health and welfare. REQUIRED EDUCATION: • Completion of an accredited Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program OR Bachelor's or master’s degree in a social science, psychology, gerontology, public health or social work OR any combination of education and experience that would provide an equivalent background REQUIRED EXPERIENCE: • At least 1 year of experience working with persons with disabilities/chronic conditions and Long Term Services & Supports. • 1-3 years in case management, disease management, managed care or medical or behavioral health settings. PREFERRED EXPERIENCE: • 3-5 years in case management, disease management, managed care or medical or behavioral health settings. • 1 year experience working with population who receive waiver services. PREFERRED LICENSE, CERTIFICATION, ASSOCIATION: Active and unrestricted Certified Case Manager (CCM) Active, unrestricted State Nursing license (LVN/LPN) OR Clinical Social Worker license in good standing. Valid driver’s license with good driving record and be able to drive within applicable state or locality with reliable transportation  
Contract Oct 30, 2024 Industrial Position: Checker/Fulfillment Department: Production Position Reports to: Production Supervisor Location: Fort Wayne, Indiana Description: The position of Checker/Fulfillment requires attention to detail, good time management skills, and flexibility. The position requires the ability to inspect the quality and sequential order of 100% of the products produced, the matching of plates to registrations and verification using a software program, to ensure the quality of the products are meeting the customer’s expectation. These tasks are to be performed in an effective and timely manner, in the comfort of a climate-controlled environment. Responsibilities: •    Verify product quality of the license plate and vehicle registration document. •    Work effectively with a team to ensure timely delivery of orders. •    Prepare orders for shipment. •    Verification of license plates to registration documentation in terms of accuracy. •    Use of computer, scanners, and software to verify document/plate matching accuracy. •    Flexibility in duties and adjusting to meet customer demands. •    All other pertinent and assigned duties. Requirements: •    Computer Experience •    Demonstrated evidence of successful teamwork •    Ability to perform Visual Color Discrimination: match or detect differences between colors, including shades of color and brightness on license plates. •    Professional and positive approach to communication •    Attention to detail and the ability to not allow oneself to be easily distracted •    Ability to multi-task •    Cross-training in other areas of the plant •    Previous production experience an asset •    Adhere to strict safety, quality, and production standards •    Required Personal protective equipment – safety toed shoes •    Work well under pressure  •    Willing to work overtime as it is required •    Must be able to lift, up to 25 lbs •    Organized and dependable •    Be punctual and ready to work •    Must pass applicable background check, including but not limited to, drug and alcohol screening test. •    High School Diploma, or equivalent required.  
Contract Oct 28, 2024 Other Area(s) Clinical Review Nurse - Prior Authorization to analyze all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's benefit coverage. This position is remote but MUST live in INDIANA. The work schedule is Mon-Fri 8:00am to 5:00pm EST. Job Duties: Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and criteria. Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care. Coordinates as appropriate with healthcare providers and interdepartmental teams, to assess medical necessity of care of member. Escalates prior authorization requests to Medical Directors as appropriate to determine appropriateness of care. Assists with service authorization requests for a member’s transfer or discharge plans to ensure a timely discharge between levels of care and facilities. Collects, documents, and maintains all member’s clinical information in health management systems to ensure compliance with regulatory guidelines. Assists with providing education to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to members. Provides feedback on opportunities to improve the authorization review process for members. Experience: Clinical knowledge and ability to analyze authorization requests and determine medical necessity of service preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. Education: Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of related experience. License/Certification: LPN - Licensed Practical Nurse - State Licensure required.
Contract Oct 21, 2024 Call Center Job Description: Intermediate knowledge of training processes, such as adult learning theories and instructional design principles. Effective facilitation skills, such as ability to facilitate open discussion in a less structured environment. Effective class preparation skills. Ability to coordinate cross state tasks and to interact with employees in all areas of the project. Ability to analyze effectiveness of training and to independently implement, with guidance from the training supervisor, appropriate solutions without compromising instructional design and adult learning theory. Ability to coach others and provide performance feedback (e.g. trainees, agents, etc.) Travel within the State of Indiana REQUIREMENTS: Education: Some college with 1 plus years experience in facilitation/trainer role or HS diploma or GED and 2 plus years experience with Indiana Eligibility Public Assistance Programs. Must be able to travel 20% - 40% within the State of Indiana Extensive knowledge of Policy and Guidelines in relation to Indiana Eligibility Public Assistance Programs (TANF, Medicaid, SNAP Preferred Experience working in IEDSS Bachelor’s Degree Coaching or training experience Training Certification Excellent communication & presentation skills PME is an equal opportunity employer. We prohibit discrimination and harassment against any applicant or employee based on any legally recognized basis, including, but not limited to: veteran status, uniformed servicemember status, race, color, religion, sex, sexual orientation, gender identity, age (40 and over), pregnancy, national origin or ancestry, citizenship status, physical or mental disability, genetic information (including testing and characteristics) or any other category protected by federal, state or local law.
Contract Oct 11, 2024 Other Area(s) Care Manager (RN) with Prenatal, Postpartum, Labor/ Delivery, Mother Baby or NICU experience to develop, assess, and facilitate complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families. Fully remote but MUST reside in Indiana. The work schedule is Monday-Friday 8am-5pm.   Develops ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and/or community resources to address member's unmet needs Care Manager completes an average of 40-50 calls per day reaching out to members who are about to or have recently delivered a baby. Conduct assessments to assess members well-being, newborn wellbeing and to assist with any needs Assist members on scheduling postpartum appointments Answer questions about postpartum and Newborn care. Documenting in specific system Education/Experience: Requires a Degree from an Accredited School of Nursing or a Bachelor's degree in Nursing and 2 – 4 years of related experience. License/Certification: RN - Registered Nurse - State Licensure and/or Compact State Licensure required
Contract Oct 10, 2024 Other Area(s) Job Title: (RN) Well Care Coordinator Location:  Remote (Bloomington, 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 Sep 30, 2024 Healthcare ilingual 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 Marion County, Indiana, willing to travel throughout central and northern 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
Contract Sep 26, 2024 Healthcare PME is actively seeking a CNA FT/PRN to assists with nursing programs as assigned. Performs a variety of tasks associated with the daily care and treatment of patients. Job Responsibilities: Administers and documents authorized medications and treatments per hospital policies and procedures. Carries out or assists with physical care of patients including bathing, feeding, taking vital signs, heights, weights, and other activities of daily living as indicated. Maintains current CPR and Bridge Building certifications. Escorts patients to and from therapies, and other areas of the hospital for treatment and programming. Escorts and/or drives patients to off-ground appointments and activities. Observes patients’ physical condition and reports changes to the RN. Appropriately and accurately reports pertinent information, both verbal and written. Appropriately applies skills in psychosocial care of patients: Encourages patients and interacts with them to socialize and participate in activities and programming. Job Requirements: High school diploma or GED Equivalent Successful completion of a Certified Nursing Assistant program Basic computer skills are required. Maintain current CPR. Bridge Building certification.
Contract Sep 3, 2024 Other Area(s) RN Case Manager to conduct UAS Assessments to support care management. The position will be a field position in Syracuse, Albany or Orange, NY.  Schedule will be M-F 8:30AM-5PM. ***MUST be RN UAS Certified. Bilingual in any language is highly preferred. Essential Functions/Responsibilities: UAS Certified RN licensed in the state of NY. Conduct face to face assessments of members’ functional status, medical, behavioral, psychosocial and community resource needs. Provides the Interdisciplinary Care Team (ICT) with assessment information and acts as facilitator to ensure that members’ needs are met. Develop an ICP/PCSP based on members’ clinical, behavioral, and social needs that addresses barriers to care. Competently assesses members’ health status and ensures that member is receiving all necessary medical and supportive services. Manage care transitions through effective and timely communication necessary for member care and discharge planning. Clarifies SWH plan medical benefits, policies and procedures for members, providers and community-based agencies. Maintain a comprehensive working knowledge of community resources, payer requirements, and network services for target population. Required Education: Bachelor's Degree (a combination of experience and education will be considered in lieu of degree). Required Licensure/Certification: NY State RN License in good standing.
Contract Aug 19, 2024 Healthcare The Community Well Care Coordinator must oversee the care coordination, complex case management functions for PathWays to Aging members who live in the community and who are not receiving Home and Community Based Services (HCBS) or designated as Nursing Facility Level of Care (NFLOC). The Care Coordinator must, at a minimum, be a registered nurse or similar medical professional with extensive experience in providing care coordination to members 60 years and older. This individual will work directly under the Health Services Directors to maintain the care coordination program. The individual will be responsible for overseeing care coordination teams, care plan development and care plan implementation. The Care Coordinator will be responsible for directing the activities of the care coordinators. These responsibilities extend to physical and behavioral health care services. This individual will work with the Heath Services Director, Service Coordinator Administrator, Medical Director, Provider and Member Services Managers, and with State staff as necessary, to communicate to providers and members. The Care Coordinator will provide input, as requested by the State, at State-level meetings. Primary Responsibilities: •    Selects, manages, develops, mentors and supports staff in designated department or region •    Develops clear goals and objectives for performance management and effectively communicates expectations, and holds the team accountable for results •    In order to meet the unique needs of our members, have an intimate understanding of the contractual requirements •    Identify, select, structure, and prioritize process improvement projects, ultimately implementing changes to meet program requirements •    Ensures standardized execution of workflow processes, including conducting performance audits, quality reviews, and compliance adherence •    Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care •    Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services •    Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members •    Advocate for patients and families as needed to ensure the patient’s needs and choices are fully represented and supported by the health care team •    Participates in training and coaching of direct reports as needed •    Conducts bi-annual field visits with direct reports to observe, provide areas of teaching, address issues and concerns and foster a good working relationship •    Collaborates across Optum and UHG and interacted with Medical Directors, Site Directors, Senior Leaders, Network, Marketing, Account Management, Quality, Product, and other stakeholders Required Qualifications: •    Resident of Indiana •    BSN with equivalent experience •    Registered Nurse with an unrestricted License in Indiana •    Experience working within the community health setting in a health care role •    Experience or knowledge of Indiana Medicaid, Medicare, Long term care •    Experience coaching or mentoring staff •    Intermediate level of experience with Microsoft Word, with the ability to navigate a Windows environment Preferred Qualifications: •    3+ year of case management leadership experience within a healthcare industry •    Background in managed care •    Case Management experience •    Certified Case Manager (CCM) •    Experience / exposure with members receiving long term social supports •    Experience in utilization review, concurrent review and/or risk management PME is an equal opportunity employer. We prohibit discrimination and harassment against any applicant or employee based on any legally recognized basis, including, but not limited to: veteran status, uniformed servicemember status, race, color, religion, sex, sexual orientation, gender identity, age (40 and over), pregnancy, national origin or ancestry, citizenship status, physical or mental disability, genetic information (including testing and characteristics) or any other category protected by federal, state or local law.
Contract Aug 17, 2024 Healthcare The Community Well Care Coordinator must oversee the care coordination, complex case management functions for PathWays to Aging members who live in the community and who are not receiving Home and Community Based Services (HCBS) or designated as Nursing Facility Level of Care (NFLOC). The Care Coordinator must, at a minimum, be a registered nurse or similar medical professional with extensive experience in providing care coordination to members 60 years and older. This individual will work directly under the Health Services Directors to maintain the care coordination program. The individual will be responsible for overseeing care coordination teams, care plan development and care plan implementation. The Care Coordinator will be responsible for directing the activities of the care coordinators. These responsibilities extend to physical and behavioral health care services. This individual will work with the Heath Services Director, Service Coordinator Administrator, Medical Director, Provider and Member Services Managers, and with State staff as necessary, to communicate to providers and members. The Care Coordinator will provide input, as requested by the State, at State-level meetings. Primary Responsibilities: •    Selects, manages, develops, mentors and supports staff in designated department or region •    Develops clear goals and objectives for performance management and effectively communicates expectations, and holds the team accountable for results •    In order to meet the unique needs of our members, have an intimate understanding of the contractual requirements •    Identify, select, structure, and prioritize process improvement projects, ultimately implementing changes to meet program requirements •    Ensures standardized execution of workflow processes, including conducting performance audits, quality reviews, and compliance adherence •    Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care •    Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services •    Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members •    Advocate for patients and families as needed to ensure the patient’s needs and choices are fully represented and supported by the health care team •    Participates in training and coaching of direct reports as needed •    Conducts bi-annual field visits with direct reports to observe, provide areas of teaching, address issues and concerns and foster a good working relationship •    Collaborates across Optum and UHG and interacted with Medical Directors, Site Directors, Senior Leaders, Network, Marketing, Account Management, Quality, Product, and other stakeholders Required Qualifications: •    Resident of Indiana •    BSN with equivalent experience •    Registered Nurse with an unrestricted License in Indiana •    Experience working within the community health setting in a health care role •    Experience or knowledge of Indiana Medicaid, Medicare, Long term care •    Experience coaching or mentoring staff •    Intermediate level of experience with Microsoft Word, with the ability to navigate a Windows environment Preferred Qualifications: •    3+ year of case management leadership experience within a healthcare industry •    Background in managed care •    Case Management experience •    Certified Case Manager (CCM) •    Experience / exposure with members receiving long term social supports •    Experience in utilization review, concurrent review and/or risk management PME is an equal opportunity employer. We prohibit discrimination and harassment against any applicant or employee based on any legally recognized basis, including, but not limited to: veteran status, uniformed servicemember status, race, color, religion, sex, sexual orientation, gender identity, age (40 and over), pregnancy, national origin or ancestry, citizenship status, physical or mental disability, genetic information (including testing and characteristics) or any other category protected by federal, state or local law.
Contract Jul 29, 2024 Other Area(s) Senior Care Manager to assesses, plans, and implements complex care management activities based on member activities to enable quality, cost-effective healthcare outcomes. Develops a personalized care plan / service plan for care members, addresses issues, and educates members and their families/care givers on services and benefit options available to receive appropriate high-quality care. The position is fully remote but may require onsite quarterly meetings. The schedule is M-F, 8:00am-5:00pm. Coordinates and manages as appropriate between the member and/or family/caregivers and the care provider team. Reviews member data to identify trends and improve operating performance and quality care. Reviews referrals information and intake assessments to develop appropriate care plans/service plans. May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources. Develops and continuously assesses ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and/or community resources needed to address member's unmet needs. Education/Experience: Requires a Degree from an Accredited School or Nursing or a Bachelor's degree in Nursing 4 – 6 years of related experience. License/Certification: RN - Registered Nurse - State Licensure and/or Compact State Licensure required