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Care Review Clinician I (56832)
Professional Management Enterprises
-
New York, NY
All UM standard Inpatient, Outpatient and Custodial Care processes and workflows for any requests, verbal notifications for denials/partial denials to both member and provider, participation in IDTs, personal queue management and clinical reviews. Required Years of Experience At least 1 2 years' experience in UM. Required Licensure / Education Licensure required is a NY S
Email Job
Posted 2 days ago
Licensed Mental Health Counselor (LMHC)
Professional Management Enterprises
-
Indianapolis, IN
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
Email Job
Posted 2 days ago
Janitor
Professional Management Enterprises
-
Indianapolis, IN
We are seeking a dedicated and detail oriented individual to join our team as a Janitor. The primary responsibility of this role is to ensure that vacated apartments are thoroughly cleaned and prepared for new occupants. The ideal candidate will have a keen eye for cleanliness, excellent time management skills, and the ability to work independently. Responsibilities Clean
Email Job
Posted 3 days ago
Member Health Assessor
Professional Management Enterprises
-
Indianapolis, IN
The Member Health Assessor engages with the member to establish an effective, professional relationship with primary responsibility to conduct their health risk assessment. Essential Functions Participate in the Integrated Care Coordination Team as needed. Coordinate logistics to support care plan goals and interventions as needed to address immediate member concerns. Ver
Email Job
Posted 3 days ago
Medical Appeals Analyst (33248992)
Professional Management Enterprises
-
Columbia, SC
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. Perf
Email Job
Posted 4 days ago
Community Well Care Coordination Manager
Professional Management Enterprises
-
Indianapolis, IN
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 simil
Email Job
Posted 4 days ago
Care Review Processor I (56811)
Professional Management Enterprises
-
Los Angeles, CA
Data Entry (Intake) enters information in system from fax system verifies eligibility, coverage, request for missing information, redirecting to in network facilities, assist in phone queue questions . Correspondence Letter generation selects correct template, minor grammar checks . Required Education High School Graduate (CRP); Some College (Correspondence Processor) Req
Email Job
Posted 4 days ago
Care Review Clinician II (56652)
Professional Management Enterprises
-
Los Angeles, CA
All UM standard Inpatient, Outpatient and Custodial Care processes and workflows for any requests, verbal notifications for denials/partial denials to both member and provider, participation in IDTs, personal queue management and clinical reviews. Must Have Skills Must have experience in UM, experience with Turnaround Timeframes, good with computer systems and be able to
Email Job
Posted 4 days ago
RN Care Manager (119447)
Professional Management Enterprises
-
Indianapolis, IN
Seeking an RN Care Manager with experience working with high risk OB members to perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members. This position is fully remote. The work schedule is M F 8 00am 5 00pm. You MUST be a Licensed RN that is good standing and residing in t
Email Job
Posted 5 days ago
Member Risk Adjustment Coordinator I (119687)
Professional Management Enterprises
-
Indianapolis, IN
Schedule appointments, gather medical histories and updated member and provider information in support of member outreach and claims reimbursement. Essentials Understanding of basic medical terminology Call center experience Good customer service skills Ability to problem solve basic computer issues Managing Excel spread sheets Work with multiple computer system Good verb
Email Job
Posted 5 days ago
Maintenance Assistant I (33040455)
Professional Management Enterprises
-
Columbia, SC
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
Email Job
Posted 6 days ago
Utilization Review RN
Professional Management Enterprises
-
Indianapolis, IN
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.
Email Job
Posted 6 days ago
Care Manager V (56732)
Professional Management Enterprises
-
Syracuse, NY
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, an
Email Job
Posted 9 days ago
Customer Service Advocate I
Professional Management Enterprises
-
Indianapolis, IN
Job Title Customer Service Advocate I Location Remote (Indiana) Hours 11am 8pm Monday Friday (Eastern Standard Time Zone) Job Description Serves as the first line advocate that focuses on resolving inquiries, issues, or concerns for members and/or providers. Leverages a variety of communication channels to provide members and/or providers with timely, accurate, and persona
Email Job
Posted 11 days ago
Clinical Appeals Nurse
Professional Management Enterprises
-
Dayton, OH
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. Re
Email Job
Posted 12 days ago
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