Powered By
Open Positions (24)
Contract May 31, 2024 Healthcare Job Title: SSB Nurse Medical Mgmt I
Location: Remote *Must be Indiana Resident
Work Schedule: 40 hours a week maximum to be worked in five eight-hour shifts across Monday through Saturday. 8AM to 5PM EST. Team currently works about 1 Saturday every 4-5 weeks but could do more Saturdays upon request.
JOB SUMMARY:
Responsible for collaborating with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources.
JOB DUTIES AND RESPONSIBILITIES:
Primary duties may include, but are not limited to:
Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs or community resources. 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.
REQUIRED SKILLS:
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. Excellent attendance.
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.
PME is an equal opportunity employer. We prohibit discrimination and harassment against any applicant or employee based on any legally recognized basis, including, but not limited to: veteran status, uniformed servicemember status, race, color, religion, sex, sexual orientation, gender identity, age (40 and over), pregnancy, national origin or ancestry, citizenship status, physical or mental disability, genetic information (including testing and characteristics) or any other category protected by federal, state or local law. Contract May 30, 2024 Healthcare
Education
Registered Nurse (RN) Degree
Have a valid RN state license
Experience
Training in crisis management techniques, trauma-informed care, and relevant experience working with individuals in crisis situations.
Strong interpersonal skills, empathy, and the ability to remain calm under pressure are essential for this role.
Nurses in this role need strong clinical skills, communication abilities, and the ability to work independently.
Job Description
Responsible for providing telephonic triage, health advice, assessing symptoms, and determining the appropriate course of action, which may include recommending self-care, scheduling appointments, or advising on emergency care.
Job Details
Educate individuals on the importance of nutrition, safety, and overall good health.
Provide knowledge and advice through our triage line.
Engage callers to assess and de-escalate uneasy situations in the least restrictive manner to ensure caller safety over the phone.
Report to assigned supervisor and actively seek consultation whenever necessary or requested by supervisor.
Build rapport with team members that fosters a team culture promoting values and vision.
Actively participate in quality improvement activities to promote continual growth and improvement in quality of services provided.
Completion of required documentation within established timeframes.
Use of an Electronic Client Record, and additional call management software.
Maintain applicable licensure requirements.
Maintain intake notes, agency resource records, and documentation.
Maintain familiarity with, and adhere to, program policies and procedures.
Maintain confidentiality of privileged information and adhere to client privacy laws.
Document all critical incidents and utilize all agency procedures for proper documentation and record keeping.
Stay up to date on all required trainings.
Pay
Negotiable
Job Type
Part-time and Full-time positions available
Shift and schedule
The three available full time shifts are:
7 a.m. to 3 p.m.
3 p.m. to 11 p.m.
11 p.m. to 3 a.m.
Sunday through Saturday
Work Setting
Remote
Contract May 30, 2024 Healthcare Job Title: (RN) Well Care Coordinator
Location: Remote (Indiana) **Must be an Indiana Resident
Hours: Monday - Friday 8am-5pm
Pay: $48hr weekly pay
Travel Requirement: 25% - 50%
Job Summary:
The Community Well Care Coordinator must oversee the care coordination, complex case management functions for PathWays to Aging members who live in the community and who are not receiving Home and Community Based Services (HCBS) or designated as Nursing Facility Level of Care (NFLOC). The Care Coordinator must, at a minimum, be a registered nurse or similar medical professional with extensive experience in providing care coordination to members 60 years and older. This individual will work directly under the Health Services Directors to maintain the care coordination program. The individual will be responsible for overseeing care coordination teams, care plan development and care plan implementation. The Care Coordinator will be responsible for directing the activities of the care coordinators. These responsibilities extend to physical and behavioral health care services. This individual will work with the Heath Services Director, Service Coordinator Administrator, Medical Director, Provider and Member Services Managers, and with State staff as necessary, to communicate to providers and members. The Care Coordinator will provide input, as requested by the State, at State-level meetings.
Primary Responsibilities:
• Selects, manages, develops, mentors and supports staff in designated department or region
• Develops clear goals and objectives for performance management and effectively communicates expectations, and holds the team accountable for results
• In order to meet the unique needs of our members, have an intimate understanding of the contractual requirements
• Identify, select, structure, and prioritize process improvement projects, ultimately implementing changes to meet program requirements
• Ensures standardized execution of workflow processes, including conducting performance audits, quality reviews, and compliance adherence
• Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care
• Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services
• Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members
• Advocate for patients and families as needed to ensure the patient’s needs and choices are fully represented and supported by the health care team
• Participates in training and coaching of direct reports as needed
• Conducts bi-annual field visits with direct reports to observe, provide areas of teaching, address issues and concerns and foster a good working relationship
• Collaborates across Optum and UHG and interacted with Medical Directors, Site Directors, Senior Leaders, Network, Marketing, Account Management, Quality, Product, and other stakeholders
Required Qualifications:
• Resident of Indiana
• BSN with equivalent experience
• Registered Nurse with an unrestricted License in Indiana
• Experience working within the community health setting in a health care role
• Experience or knowledge of Indiana Medicaid, Medicare, Long term care
• Experience coaching or mentoring staff
• Intermediate level of experience with Microsoft Word, with the ability to navigate a Windows environment
Preferred Qualifications:
• 3+ year of case management leadership experience within a healthcare industry
• Background in managed care
• Case Management experience
• Certified Case Manager (CCM)
• Experience / exposure with members receiving long term social supports
• Experience in utilization review, concurrent review and/or risk management
PME is an equal opportunity employer. We prohibit discrimination and harassment against any applicant or employee based on any legally recognized basis, including, but not limited to: veteran status, uniformed servicemember status, race, color, religion, sex, sexual orientation, gender identity, age (40 and over), pregnancy, national origin or ancestry, citizenship status, physical or mental disability, genetic information (including testing and characteristics) or any other category protected by federal, state or local law. Direct Hire May 29, 2024 Accounting Job Title: Payroll Clerk
Location: 9245 N. Meridian St., Ste. 210 Indianapolis, IN 46260
Hours: 9am – 4:30pm, Monday - Wednesday (Part-Time)
Pay Range: $17hr - $19hr **Weekly Pay
Payroll Clerk Job Description:
• Data entry
• Auditing new hire and terminated employees (cross checking tax and direct deposit information and any other payroll related item to ensure timely payment)
• Contacting employees with timesheet discrepancies via email and telephone
• Assisting with missing local code discrepancies
• Updating direct deposit and tax information and verification process
• Pulling approved timesheets from Fieldglass, Beeline, and WAND
• Overseeing BKG payroll email box
• Communicating with supervisors and approvers on timesheet questions and discrepancies
• Assisting with garnishments
• Preparing and reconciling monthly payroll journal entry to QB
• Maintaining Payroll Clearing Account in QB
• Assisting Payroll/Accounting Dept. as needed
Requirements:
Minimum experience – 1 to 3 years in a payroll environment.
Proficiency in Paylocity (payroll system), Outlook, Word, and Excel at an entry-level
HS Diploma, Associate's degree is preferred
A friendly demeanor, with an eagerness to learn, and a commitment to professional growth.
Skills:
Analytical Skills
Attention to Detail
Deadline-driven
Problem Solving
Data Entry Skills
Confidentiality
General Math Skills
Familiarity with General Accounting Principles
Communication Skills
Organizational Skills
Microsoft Office – Excel/Word
PME is an equal opportunity employer. We prohibit discrimination and harassment against any applicant or employee based on any legally recognized basis, including, but not limited to: veteran status, uniformed servicemember status, race, color, religion, sex, sexual orientation, gender identity, age (40 and over), pregnancy, national origin or ancestry, citizenship status, physical or mental disability, genetic information (including testing and characteristics) or any other category protected by federal, state or local law.
Contract May 29, 2024 Other Area(s) Event Coordinator to support Community Engagement Specialists with major event planning and supply orders. Coordinate the distribution of marketing materials. As directed, collaborate with the Communications and Marketing Departments in the development of event invitations, flyers, newsletters and other communications. This position requires the candidate to reside in Yakima, Tri Cities Richland, Kennewick or Pasco- Washington, WASHINGTON and be Bilingual. The hours will vary up to 20 hours per week. Will have a set schedule but likely not M-F. Business Casual dress code. Will be working at events setting up in clinics. Must have valid driver’s license and reliable transportation to be able to transport materials to events.
Essential Responsibilities:
Assist with the development of Community Engagement reports and informational materials.
Provides guidance and oversight of the Volunteer Time Off (VTO) program and assist with the recruitment and training of event volunteers.
Assists in planning and organizing project activities.
Collaborates with internal and external parties to assist with organizing the various components needed to initiate, run and conclude major projects.
Retrieves data from a variety of sources for complying with financial, legal and/or administrative requirements.
Identifies and reports departmental operational issues and resource needs to the appropriate management personnel.
Presents information on administrative department procedures, services, regulations, etc. for orienting other personnel and/or disseminating information to appropriate parties.
Confirm event location, arrival and audience.
Disseminate information related to Molina lines of business.
Engage members and prospective members in Molina value proposition.
Required Years of Experience: 2+ years of event and meeting planning; and project coordination with defined deadlines and task tracking.
Required Licensure / Education: Associate degree or equivalent combination of education and experience
Contract May 29, 2024 Other Area(s) The Marketing Specialist is responsible for supporting the growth marketing operations team. The Specialist will work closely with the Print Production Manager and cross-functionally with Marketing Operations, Content Development, Compliance, Brand as well as third party vendors. The primary focus will be working on prospect direct mail operations. No design work, just execution and vendor management with print partners. This is a fully remote position. The work schedule is Mon-Fri, 8:00am - 5:00pm EST.
Day to Day Responsibilities:
Work strategically, under the guidance of the Print Production manager, to understand prospect and member mailing initiatives and build mail plans to support.
Build work back timelines to ensure all stakeholders and vendors are aware of deliverables and due dates.
Manage the work amongst internal and external teams from creative development to mail drop date.
Assist in the delivery of art and data files for Operations materials as needed to meet production and fulfillment deadlines.
Gather print specifications, quantity and version information and provide print and fulfillment vendors as needed for execution.
Understand and assist in monitoring and managing ongoing program statuses of vendor SLA’s and CMS requirements, and update status reports.
Work closely with the IT team(s) and responsible stakeholder(s) to understand programming of member data into vendor system.
Conduct print proofing and personalization auditing and required materials.
Meet with Production Manager and business owners as needed to review and understand details of print and fulfillment business requirements for various printed communications.
Manage material digital files in on-line order portal and monitor order activity and troubleshoot issues through resolution.
Input and manage projects into company procurement database.
Review, reconcile, route, and submit all invoices for payment and maintain reporting of all project expenses.
Manage ad hoc projects from start to finish as needed.
Establish and maintain collaborative working relationships with team members, internal clients and external vendors.
Reporting projects such as mail dates, postal charges, print cost / fulfillment charges, inventory pulls and reorders.
Support the overall business goals by performing additional duties as assigned or requested.
Must Have Skills:
Three 3+ years of Marketing, Direct Mail and/or Project Management experience working in a fast-paced environment preferred.
Basic understanding of production and distribution methods, technology, equipment and processes for printing, direct mail and fulfillment, including USPS regulations, preferred.
Proven Experience interfacing with business decision-makers to prioritize and achieve desired outcomes.
Knowledge of Microsoft applications and ability to quickly learn internal software systems required.
Project Management skills to simultaneously manage multiple projects.
Strong attention to detail.
Excellent time management skills and able to work to strict deadlines.
Highly organized.
Ability to work well with people in a constantly changing environment.
Strong written and verbal communication skills.
Competencies in creating project documentation and tracking projects.
Required Years of Experience:
Bachelor’s or Associates degree or two (2) or more years of applicable experience in Healthcare/Medicare print/mail production or project management required.
Contract May 24, 2024 Healthcare Bilingual candidates are encouraged to apply!
Involved in the development, presentation and delivery of community outreach initiatives, activities and market strategies to support the Medicaid business and drive membership retention and growth.
Must be an Indiana resident who resides in or near County, Indiana, willing to travel throughout southern Indiana
Conduct outreach activities for community members that are Aged, Blind, and Disabled
Collaborate with local agencies and medical providers that serve the HCC and PathWays populations
Educate and network with people of diverse backgrounds and cultures
Report feedback from the field to further develop and enhance UHCCP programming
Minimum Qualification, Training, and Experience:
Five or more years of education and/or experience in the health services field, with a preference for a candidate who is a
Certified Community Health Worker preferred
Valid Indiana driver’s license required
Reliable transportation required
Travel up to 75% of the time within assigned territory
Willing to work a flexible 40-hour week, including evenings and weekends
Able to transport, lift, carry and set up promotional materials
Smartphone capable of installing Microsoft Office, Zoom, SalesForce, Google Drive, Slack and others, as necessary
Basic computer skills and knowledge of office programs, with the ability to learn new ones
Experience in outreach and linking the community to local resources
Able to deliver presentations and conduct meetings
Flexible to adjust job responsibilities as the position evolves
No fields configured
Contract May 24, 2024 Healthcare Job Title: (Social Worker) Well Care Coordinator
Location: Remote (Indiana) **Must be an Indiana Resident
Hours: Monday - Friday 8am-5pm
Pay: $38hr 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
• BSW with equivalent experience
• Experience working within the community health setting in a health care role
• Experience or knowledge of Indiana Medicaid, Medicare, Long term care
• Experience coaching or mentoring staff
• Intermediate level of experience with Microsoft Word, with the ability to navigate a Windows environment
Preferred Qualifications:
• 3+ year of case management leadership experience within a healthcare industry
• Background in managed care
• Case Management experience
• Certified Case Manager (CCM)
• Experience / exposure with members receiving long term social supports
• Experience in utilization review, concurrent review and/or risk management
PME is an equal opportunity employer. We prohibit discrimination and harassment against any applicant or employee based on any legally recognized basis, including, but not limited to: veteran status, uniformed servicemember status, race, color, religion, sex, sexual orientation, gender identity, age (40 and over), pregnancy, national origin or ancestry, citizenship status, physical or mental disability, genetic information (including testing and characteristics) or any other category protected by federal, state or local law. Contract May 23, 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 May 23, 2024 Healthcare The Community Well Care Coordination Manager must oversee the care coordination, complex case management functions for PathWays to Aging members who live in the community and who are not receiving Home and Community Based Services (HCBS) or designated as Nursing Facility Level of Care (NFLOC). The Care Coordination Manager must, at a minimum, be a registered nurse or similar medical professional with extensive experience in providing care coordination to members 60 years and older. This individual will work directly under the Health Services Directors to maintain the care coordination program. The individual will be responsible for overseeing care coordination teams, care plan development and care plan implementation. The Care Coordination Manager will be responsible for directing the activities of the care coordinators. These responsibilities extend to physical and behavioral health care services. This individual will work with the Heath Services Director, Service Coordinator Administrator, Medical Director, Provider and Member Services Managers, and with State staff as necessary, to communicate to providers and members. The Care Coordination Manager will provide input, as requested by the State, at State-level meetings.
Primary Responsibilities:
• Selects, manages, develops, mentors and supports staff in designated department or region
• Develops clear goals and objectives for performance management and effectively communicates expectations, and holds the team accountable for results
• In order to meet the unique needs of our members, have an intimate understanding of the contractual requirements
• Identify, select, structure, and prioritize process improvement projects, ultimately implementing changes to meet program requirements
• Ensures standardized execution of workflow processes, including conducting performance audits, quality reviews, and compliance adherence
• Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care
• Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services
• Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members
• Advocate for patients and families as needed to ensure the patient’s needs and choices are fully represented and supported by the health care team
• Participates in training and coaching of direct reports as needed
• Conducts bi-annual field visits with direct reports to observe, provide areas of teaching, address issues and concerns and foster a good working relationship
• Collaborates across Optum and UHG and interacted with Medical Directors, Site Directors, Senior Leaders, Network, Marketing, Account Management, Quality, Product, and other stakeholders
Required Qualifications:
• Resident of Indiana
• BSN or BSW with equivalent experience
• Registered Nurse with an unrestricted License in Indiana
• Experience working within the community health setting in a health care role
• Experience or knowledge of Indiana Medicaid, Medicare, Long term care
• Experience coaching or mentoring staff
• Intermediate level of experience with Microsoft Word, with the ability to navigate a Windows environment
Preferred Qualifications:
• 3+ year of case management leadership experience within a healthcare industry
• Background in managed care
• Case Management experience
• Certified Case Manager (CCM)
• Experience / exposure with members receiving long term social supports
• Experience in utilization review, concurrent review and/or risk management
Contract May 23, 2024 Healthcare Job Title: (RN) Well Care Coordinator
Location: Remote (Indiana) **Must be an Indiana Resident
Hours: Monday - Friday 8am-5pm
Pay: $48hr weekly pay
Travel Requirement: 25% - 50%
Job Summary:
The Community Well Care Coordinator must oversee the care coordination, complex case management functions for PathWays to Aging members who live in the community and who are not receiving Home and Community Based Services (HCBS) or designated as Nursing Facility Level of Care (NFLOC). The Care Coordinator must, at a minimum, be a registered nurse or similar medical professional with extensive experience in providing care coordination to members 60 years and older. This individual will work directly under the Health Services Directors to maintain the care coordination program. The individual will be responsible for overseeing care coordination teams, care plan development and care plan implementation. The Care Coordinator will be responsible for directing the activities of the care coordinators. These responsibilities extend to physical and behavioral health care services. This individual will work with the Heath Services Director, Service Coordinator Administrator, Medical Director, Provider and Member Services Managers, and with State staff as necessary, to communicate to providers and members. The Care Coordinator will provide input, as requested by the State, at State-level meetings.
Primary Responsibilities:
• Selects, manages, develops, mentors and supports staff in designated department or region
• Develops clear goals and objectives for performance management and effectively communicates expectations, and holds the team accountable for results
• In order to meet the unique needs of our members, have an intimate understanding of the contractual requirements
• Identify, select, structure, and prioritize process improvement projects, ultimately implementing changes to meet program requirements
• Ensures standardized execution of workflow processes, including conducting performance audits, quality reviews, and compliance adherence
• Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care
• Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services
• Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members
• Advocate for patients and families as needed to ensure the patient’s needs and choices are fully represented and supported by the health care team
• Participates in training and coaching of direct reports as needed
• Conducts bi-annual field visits with direct reports to observe, provide areas of teaching, address issues and concerns and foster a good working relationship
• Collaborates across Optum and UHG and interacted with Medical Directors, Site Directors, Senior Leaders, Network, Marketing, Account Management, Quality, Product, and other stakeholders
Required Qualifications:
• Resident of Indiana
• BSN with equivalent experience
• Registered Nurse with an unrestricted License in Indiana
• Experience working within the community health setting in a health care role
• Experience or knowledge of Indiana Medicaid, Medicare, Long term care
• Experience coaching or mentoring staff
• Intermediate level of experience with Microsoft Word, with the ability to navigate a Windows environment
Preferred Qualifications:
• 3+ year of case management leadership experience within a healthcare industry
• Background in managed care
• Case Management experience
• Certified Case Manager (CCM)
• Experience / exposure with members receiving long term social supports
• Experience in utilization review, concurrent review and/or risk management
PME is an equal opportunity employer. We prohibit discrimination and harassment against any applicant or employee based on any legally recognized basis, including, but not limited to: veteran status, uniformed servicemember status, race, color, religion, sex, sexual orientation, gender identity, age (40 and over), pregnancy, national origin or ancestry, citizenship status, physical or mental disability, genetic information (including testing and characteristics) or any other category protected by federal, state or local law. Contract May 23, 2024 Other Area(s) Program Specialist (Social Worker) to conduct screening and risk assessment interventions per program guidelines. Assist with non-medical aspects of the member’s care, including referrals to community resources. Work schedule is M-F 8:00am-5:00pm. This position is remote, but MUST reside in INDIANA.
Job Responsibilities: Identify special needs members through the completion of health screens and other resources Work with community outreach/member advocates to coordinate member care Educate providers and community resources on program components and available support services Educate members with special needs to foster compliance with program and positively impact outcomes Conduct site visits as appropriate for programs and provide support to other special programs Develop and modify care plans in conjunction with member, member’s family and managing physician Development of plan specific literature and education materials in conjunction with medical director and corporate oversight.
Education/Experience: Bachelor’s degree in Social Work, Nursing, Health, Behavioral Science or Equivalent Experience. Experience in a managed care environment preferred. 0-2 years of experience
Contract May 23, 2024 Administrative Responsibility:
-- Provide a wide range of administrative assistance to two programs within the Food Protection Division.
-- Act as a liaison between program or department administration, state agencies, and other stakeholders.
-- Provide routine policy interpretation and related decisions to stakeholders.
-- Research and prepare various reports for manager.
-- Prepare and processes correspondence and verbally communicates with the public or other agency representatives. Directs incoming correspondence to the appropriate individual.
-- Reviews and inspects incoming documents for accuracy, completeness, and to ensure dompliance with applicable federal, state, and local rules and regulations. Obtains necessary approvals if needed.
-- Provides technical guidance and composes manuals for agency personnel.
-- Coordinates clerical and administrative functions.
-- Other duties as assigned.
Job Requirements:
-- High School Diploma or equivalent.
-- 3 years full time experience performing administrative support, bookkeeping, office management, or related experience.
-- General knowledge of office administrative functions, theories, and principles.
-- Working knowledge of research techniques and report composition.
-- Working knowledge of functions of other departments and agencies and their impact on the department.
-- Effective written and verbal communication skills.
-- Attention to detail and proofreading skills.
-- Organizational skills with the ability to prioritize tasks effectively and multitask
-- Ability to use Microsoft Office Suite (Word, Excel, PowerPoint, Outlook)
-- Ability to analyze procedures and policies and writes procedural manuals to recommend improvements.
-- Ability to coordinate the work of the RRT and Produce Safety Teams.
-- Ability to maintain cooperative work relationships. Contract May 23, 2024 Healthcare The Community Well Care Coordination Manager must oversee the care coordination, complex case management functions for PathWays to Aging members who live in the community and who are not receiving Home and Community Based Services (HCBS) or designated as Nursing Facility Level of Care (NFLOC). The Care Coordination Manager must, at a minimum, be a registered nurse or similar medical professional with extensive experience in providing care coordination to members 60 years and older. This individual will work directly under the Health Services Directors to maintain the care coordination program. The individual will be responsible for overseeing care coordination teams, care plan development and care plan implementation. The Care Coordination Manager will be responsible for directing the activities of the care coordinators. These responsibilities extend to physical and behavioral health care services. This individual will work with the Heath Services Director, Service Coordinator Administrator, Medical Director, Provider and Member Services Managers, and with State staff as necessary, to communicate to providers and members. The Care Coordination Manager will provide input, as requested by the State, at State-level meetings.
Primary Responsibilities:
• Selects, manages, develops, mentors and supports staff in designated department or region
• Develops clear goals and objectives for performance management and effectively communicates expectations, and holds the team accountable for results
• In order to meet the unique needs of our members, have an intimate understanding of the contractual requirements
• Identify, select, structure, and prioritize process improvement projects, ultimately implementing changes to meet program requirements
• Ensures standardized execution of workflow processes, including conducting performance audits, quality reviews, and compliance adherence
• Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care
• Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services
• Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members
• Advocate for patients and families as needed to ensure the patient’s needs and choices are fully represented and supported by the health care team
• Participates in training and coaching of direct reports as needed
• Conducts bi-annual field visits with direct reports to observe, provide areas of teaching, address issues and concerns and foster a good working relationship
• Collaborates across Optum and UHG and interacted with Medical Directors, Site Directors, Senior Leaders, Network, Marketing, Account Management, Quality, Product, and other stakeholders
Required Qualifications:
• Resident of Indiana
• BSN or BSW with equivalent experience
• Registered Nurse with an unrestricted License in Indiana
• Experience working within the community health setting in a health care role
• Experience or knowledge of Indiana Medicaid, Medicare, Long term care
• Experience coaching or mentoring staff
• Intermediate level of experience with Microsoft Word, with the ability to navigate a Windows environment
Preferred Qualifications:
• 3+ year of case management leadership experience within a healthcare industry
• Background in managed care
• Case Management experience
• Certified Case Manager (CCM)
• Experience / exposure with members receiving long term social supports
• Experience in utilization review, concurrent review and/or risk management
PME is an equal opportunity employer. We prohibit discrimination and harassment against any applicant or employee based on any legally recognized basis, including, but not limited to: veteran status, uniformed servicemember status, race, color, religion, sex, sexual orientation, gender identity, age (40 and over), pregnancy, national origin or ancestry, citizenship status, physical or mental disability, genetic information (including testing and characteristics) or any other category protected by federal, state or local law. Contract May 21, 2024 Other Area(s) Care Engagement Specialist to be responsible for supporting the organization’s goals of obtaining health needs screenings, scheduling preventive service appointments, and educating members on plan benefits and services. Provide members with educational materials and carry out strategies to increase health care adherence and reduce barriers to care. MUST reside in Indiana. Schedule: Mon-Fri 9am-6pm Remote
Job Responsibilities:
Make outbound or receive inbound calls from members to schedule doctor appointments, assist members that need to complete Health Needs Screenings or make payments to become eligible for enhanced benefits.
Influence members to take advantage of additional benefits.
Educate members on utilization of Emergency Departments in non-emergent conditions.
Identify and overcome barriers for members to complete needed health screenings, obtain needed services or make payments to secure enhanced benefits.
Review each member profile prior to outreach to identify areas of opportunity.
Participate in continuous quality improvement initiatives to ensure department and company goals are met.
Review and analyze data for call reports to make adjustments as needed.
Act as a secondary resource for the Member Services or Provider Services call centers.
Education/Experience: High School diploma or equivalent and 0-2 years of sales experience in a call center or other high-pressure sales environment. Bilingual in Spanish and English preferred.
Contract May 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. Performs appeal and retrospective reviews demonstrating ability to define and determine precedence of pertinent issues in application of policies and procedures to clinical information and or application to benefit or policy provisions.
Required Skills and Abilities: 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. Analytical or critical thinking skills.
Required Software and Tools: Microsoft Office.
Preferred Skills and Abilities: Administrative Law Judge (ALJ) process. Knowledge of statistical principles. Knowledge of National Committee for Quality Assurance (NCAG). Knowledge of Utilization Review Accreditation Commission (URAC). Knowledge of South Carolina Department of Insurance (SCDOI). Knowledge of US DOL and Health Insurance Portability/Accountability Act (HIPAA) standards/regulations. Excellent organizational and time management skills. Knowledge of claims systems. Presentation skills.
Required 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 from the United States and in the state of hire, 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 To Hire May 13, 2024 Other Area(s) Performs routine facility maintenance tasks to ensure company employees have a safe and properly conditioned work environment. Assemble, relocate, and repair free standing or modular office furniture and equipment. Perform general maintenance tasks. Clean equipment, mechanical rooms, and work sites as directed. Perform preventative inspections. Respond to emergency calls after normal working hours.
Schedule: Monday-Friday 8-4:30pm
Location: I-20 and Alpine Road Columbia, South Carolina 29219
Required Skills and Abilities:
Ability to lift 50 pounds frequently. Good judgment. Customer service skills. Ability to care for tools and material of the electric trade. Ability to follow verbal and written instruction. Required Software and Tools: Ability to use various hand tools. Ability to use or learn to use key cutting machine.
Contract May 7, 2024 Healthcare The Clinical Appeals Nurse is responsible for the completion of clinical appeals and state hearings from all states.
Essential Functions:
• Responsible for the completion of clinical appeals and state hearings from all states
• Review and complete all provider clinical appeals within required timeframes.
• Review and complete member clinical appeals within required timeframes.
• Review all information necessary to prepare State Hearing packets.
• Communicate with state agencies and internal departments to prepare for State Hearings
• Attend assigned State Hearing and completed all required compliances.
• Complete required compliances for Administrative Hearing decisions
• Apply CareSource Medical Policy and Milliman guidelines when processing clinical appeals.
• Issue notification letters to providers and members.
• Issue administrative denials appropriately.
• Refer denials based on medical necessity to medical director.
• Maintain hardcopy documentation, Facets documentation and appeals database documentation at 90-95% accuracy rates.
• Conduct monthly, quarterly, and ad hoc appeals reporting.
• Collaborate with the Quality Improvement and Clinical Operations Team Lead to prepare all requests for Independent External Review
• Ensure compliance with regulatory and accrediting requirements.
• Perform any other job duties as requested.
Education and Experience:
• RN License required.
• Associate degree or equivalent years of relevant experience required.
• Managed care, appeals, and Medicaid experience preferred.
• Utilization review experience is strongly preferred.
•
Competencies, Knowledge, and Skills:
• Intermediate proficiency with Microsoft Office products and Facets
• Knowledge of NCQA, URAC, OAC, and MDCH regulations
• Strong written and oral communication skills
• Ability to work independently and within a team environment.
• Critical listening and thinking skills.
• Proper grammar usage
• Time management skills
• Proper phone etiquette
• Customer Service oriented
• Decision making/problem solving skills.
• Familiarity of healthcare field
• Knowledge of Medicaid
• Flexibility
• Change resiliency.
Licensure and Certification:
• Current, unrestricted license as a Registered Nurse (RN) is required.
• MCG Certification is required or must be obtained within six (6) months of hire.
Working Conditions:
• General office environment; may be required to sit or stand for extended periods of time.
Contract May 2, 2024 Other Area(s) PME is looking for a Healthcare Case Manager I (RN, LCSW, LMSW) experienced in Case Management working with complex medical and mental illness cases. The position will require field visits 3 days a week and the rest will be from home. Schedule M-F 8:30am-5:00pm CST.
MUST live in within 30 minutes of ARLINGTON HEIGHTS, BARTLETT, HANOVER PARK, BARRINGTON, ELGIN, MOUNT PROSPECT, HOFFMAN ESTATES, PALATINE, ROLLING MEADOWS, ROSELLE, SCHAUMBURG, STREAMWOOD, WHEELING
Responsible for health care management and coordination of healthcare members
Works with members to create and implement an integrated collaborative plan of care.
Coordinates and monitors Healthcare members’ progress and services.
Provides case management services to members with chronic or complex conditions.
Proactively identifies members that may qualify for potential case management services.
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.
Identifies, assesses, and manages members per established criteria.
Develops and implements a case management plan in collaboration with the member, care team.
Performs ongoing monitoring of the plan of care to evaluate effectiveness.
Documents care plan progress in healthcare information system.
Requirements
Healthcare Case Management experience
RN, LPN or bachelors in social service or related field.
0-2 years of clinical experience with case management experience
Active, unrestricted State RN or LPN license or Licensed Clinical Social Worker LCSW or Advanced Practice Social Worker APSW in good standing
Familiarity with NCQA standards, state/federal regulations, and measurement techniques. In depth knowledge of CCA and/or other Case Management tools.
Required Experience
0-2 years of clinical experience with case management experience.
Required Licensure/Certification: Active, unrestricted State Nursing license or Licensed Clinical Social Worker LCSW or Advanced Practice Social Worker APSW in good standing.
Must have a valid driver’s license with a good driving record and be able to drive locally if required.
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 30, 2024 Administrative Job Summary
Data Capture Specialist is responsible for the accurate capture of the alphabetic, numeric, or symbolic data from electronic images and/or source documents according to the custom developed software application including repair of incorrect data resulting from OCR process (optical character recognition results).
Pay Rate: $14.85hr (Weekly Pay)
Work Schedule
Monday (9:00 am – 6:00 pm)
Tuesday (9:30 am – 5:30 pm)
Wednesday – Friday (9:00 am – 5:30 pm)
Duties and Responsibilities
The responsibilities of the Data Capture Specialist are outlined as follows and no intended to be all inclusive:
Enters alphabetic, numeric, or symbolic data from electronic images utilizing the Captiva Input Accel software application to capture the appropriate data including repairing any rejected characters as a result of the OCR function.
Routes electronic data to next work flow process when completed or in the case of undefined documents or documents that are not able to be indexed, may need to route electronic image to next work flow process.
Responds to inquiries regarding the status of data capture, rejected character repair, or quality assurance phases of the data capture process.
Follows proper procedures, rules, and processes for data capture and quality assurance of the data as outlined in the procedures manual.
Utilizes appropriate and compliant safeguards to reasonably prevent the use or disclosure of confidential and protected information including Protected Health Information (PHI) and Personally Identifiable Information (PII) and reports any concerns to the Document Center Operations Manager.
Data Capture Specialist must be a team player and required to assist the entire team in meeting the Key Performance Indicators (KPI) requirements.
90% of documents are scanned, indexed and entered into the database on the same business day of receipt by Doc Center if received prior to 7:15 pm.
90% of documents are scanned, indexed and entered into the database by Noon of the following business day if received after 7:15 pm.
100% of documents are scanned within two business days of receipt by Doc Center.
Competencies
To perform the job successfully, an individual should demonstrate the following competencies:
Quality: Demonstrates accuracy and thoroughness; looks for ways to improve and promote quality; applies feedback to improve performance; monitors own work to ensure quality. Must meet standards of quality that are required to meet the service levels and performance standards outlined in the SLA/KPI’s.
Quantity: Meets productivity standards; completes work in timely manner; strives to increase productivity; works accurately and efficiently.
Dependability: Follows instructions; responds to management direction; takes responsibility for own actions; maintains the production schedule requirements; commits to extended hours of work when necessary to reach daily production schedules and meets the daily service levels and performance standards; completes tasks on time or notifies supervisor of any potential delays or inabilities to meet the daily service levels and performance standards (SLA/KPI) requirements.
Adaptability: Adapts to changes in the work environment; manages competing demands; changes approach or method as directed by supervisor; exhibits ability to deal with change or unexpected events.
Job Requirements
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily, with or without accommodations. The requirements listed below are representative of the knowledge, skill, and/or ability required.
Education/Experience
Previous work experience helpful.
High School Diploma or equivalent required.
Essential Functions: Knowledge, Skills, Abilities
Proficient computer skills
Ability to track work and document routinely
Manual dexterity with proficient hand-eye coordination
Excellent verbal communication skills
Regular and timely attendance on the job
Physical Demands and Work Environment
The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is frequently required to sit, talk, hear, and use hands to write, type, handle, or feel. Specific vision abilities required by this job include close vision. Specific lifting requirements include ability to lift and move trays weighing up to 20 pounds.
The noise level in the work environment is usually moderate and the work environment includes proximity to many individuals like a public environment. Contract Apr 24, 2024 Other Area(s) Seeking a RN to function as a Medical Affairs Coordinator. This position if fully remote. The schedule is M-F, 9am-5pm.
DUTIES:
Ensures that the Local Coverage Determination (LCD) process adheres to contract instructions. Creates, implements, and maintains educational tools to help providers reduce the submission of claims for non-covered services and reduce the claims payment error rate. Provides clinical expertise, research, and judgment to develop Local Coverage Determinations (LCDS). Provides clinical input for internal requests. Serves as reviewer to determine inter-rater reliability.
Required Skills and Abilities:
Knowledge of managed care or medical claims payment policy issues. Excellent verbal and written communication skills. Excellent customer service, organizational, presentation, analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion.
Required Software and Tools:
Microsoft Office. Working knowledge of database software. Knowledge of government/healthcare programs and contracts laws, regulations, coding, and approval practices. Knowledge of corporate administrative/medical policy for all lines of business. Knowledge of guidelines, benefits, and coverage for all lines of business.
Preferred Software and Tools: Working knowledge of Microsoft Access or other database software, DB2 and Easytrieve.
EDUCATION/REQUIREMENTS:
Bachelor's degree - Nursing or other health related field. OR, Associate's degree in Nursing with an active unrestricted RN license from the United States and in the state of hire.
Required Work Experience:
5 years clinical experience in medical insurance, managed care, case management, or claims management, or a combination of these areas.
Required License and Certificate:
An active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC).
DUTIES:
Ensures that the Local Coverage Determination (LCD) process adheres to contract instructions. Creates, implements, and maintains educational tools to help providers reduce the submission of claims for non-covered services and reduce the claims payment error rate. Provides clinical expertise, research, and judgment to develop Local Coverage Determinations (LCDS). Provides clinical input for internal requests. Serves as reviewer to determine inter-rater reliability.
Required Skills and Abilities:
Knowledge of managed care or medical claims payment policy issues. Excellent verbal and written communication skills. Excellent customer service, organizational, presentation, analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion.
Required Software and Tools:
Microsoft Office. Working knowledge of database software. Knowledge of government/healthcare programs and contracts laws, regulations, coding, and approval practices. Knowledge of corporate administrative/medical policy for all lines of business. Knowledge of guidelines, benefits, and coverage for all lines of business.
Preferred Software and Tools: Working knowledge of Microsoft Access or other database software, DB2 and Easytrieve.
EDUCATION/REQUIREMENTS:
Bachelor's degree - Nursing or other health related field. OR, Associate's degree in Nursing with an active unrestricted RN license from the United States and in the state of hire.
Required Work Experience:
5 years clinical experience in medical insurance, managed care, case management, or claims management, or a combination of these areas.
Required License and Certificate:
An active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC).
Contract Apr 23, 2024 Other Area(s) DUTIES
Analyzes current operational functions and offers and implements improvements. Maintains databases and extracts data for analysis from multiple systems and departments using various data manipulation and extraction techniques. Runs and reviews reports, analyzing results in support of operational functions. Summarizes findings and communicates results to management. Identifies operational inadequacies and uses various skills and resources to retool processes.
Required Skills and Abilities:
Good organizational, customer service, communications, and analytical skills. Ability to use complex mathematical calculations and understand mathematical and statistical concepts. Knowledge of relevant computer support systems.
Required Software and Tools:
Microsoft Office. Ability to acquire programming skills across various software platforms. Preferred Skills and Abilities: Negotiation or persuasion skills. Ability to acquire knowledge of ICD9/CPT4 coding. SAS and/or DB2, or another relational database.
EDUCATION/REQUIREMENTS
Required Education: Bachelor's degree Statistics, Computer Science, Mathematics, Business, Healthcare, or another related field. or 2-year degree in Computer Science, Business or related field and 2 years of reporting and data analysis work experience OR 4 years reporting and data analysis experience. Required Work Experience: See Education. Preferred Work Experience: 2 Years-Related research and analysis experience.
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 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.