HJ Staffing

• Lead the assessment and implementation of the PeopleSoft Person Model • Design and maintain solutions using the full PeopleTools suite • Review, modify, and support COBOL programs tied to HCM batch processes • Build and optimize integrations between PeopleSoft and external systems • Evaluate current configurations to recommend scalable implementation approaches • Create high-quality technical documentation and provide hands-on training to internal teams

We are looking for a Jiva Application Analyst II to join our Application Services team. Candidate MUST have 3-5 years working with Jiva Care Management platform. As an Analyst II, you are at the "full working level" of our series. You’ll handle medium-level product configuration tasks that require a deep dive into business and system expertise. You’ll sit right in the sweet spot of our department—more advanced than our entry-level roles, while collaborating closely with our senior analysts on high-level system architecture and tactical plan projects. What You Will Do - System Optimization: Perform troubleshooting and resolve issues for core systems, internal developments, and vendor integrations. - Configuration & Testing: Assist in designing, testing, and documenting configuration solutions and evaluating departmental workflows for better efficiency. - Project Support: Participate in the full software lifecycle, from defining project scope and gathering requirements to implementing tactical plan projects. - Regulatory Alignment: Help interpret policy changes from DHCS, DMHC, and CMS to ensure our systems remain compliant. - Reporting: Generate operational and system reports to keep leadership informed on system health and performance. - Training & Mentorship: Act as a technical resource for staff, developing training materials and facilitating sessions to ensure the team is proficient in our core systems. What You Will Bring - Education: Bachelor’s degree in Business, IT, Health Care, or a related field. (A Master’s degree plus 1 year of experience also qualifies). - Jiva Expertise: 3–5 years of hands-on experience with the Jiva Care Management platform is strictly required. - Industry Experience: A minimum of 3 years of product configuration or business systems analysis experience within a managed health care environment. - Technical Savvy: Proficiency in SharePoint, MS Office (Excel, Visio, etc.), and a solid understanding of the software product lifecycle (SDLC). - Domain Knowledge: Familiarity with Medicaid/Medicare, national diagnostic coding, and regulatory policies (Medi-Cal experience is a plus). - Agile Mindset: Some knowledge of Agile/Scrum environments and Application Lifecycle Management methodologies. You Will Be Successful If... - You can translate complex business needs into detailed product requirements. - You are a problem-solver who knows when to handle an issue and when to escalate. - You enjoy collaborating with a diverse range of stakeholders, from technical devs to clinical staff. - You are organized enough to manage multiple projects simultaneously without breaking a sweat. - You have a knack for training others and can adjust your communication style for any audience. Additional Details - Remote Work: This position is 100% remote. - Schedule: Monday through Friday, 8:00 AM to 5:00 PM Pacific Time (PT). Candidates must be comfortable working these specific hours regardless of their local time zone.

We are seeking a detail-oriented OpenText Exstream Developer to join our team on a part-time basis. In this role, you will be the technical steward of our member and provider communications. Your mission is to ensure that critical documents—from ID cards to EOBs—are accurate, compliant, and delivered seamlessly. This position is 100% remote. You will focus on maintaining and enhancing our template library while ensuring tight integration with the HealthRules Connector. If you enjoy the intersection of complex data mapping and high-stakes healthcare compliance, we want to hear from you. What You Will Do - Template Mastery: Maintain and enhance OpenText Exstream templates for core health plan correspondence, including EOBs, EOPs, ID cards, COBRA notices, and welcome letters. - System Integration: Integrate Exstream with the HealthRules Connector Correspondence module, managing both XML and flat-file data feeds. - Production Support: Rapidly troubleshoot production defects and resolve member communication issues to ensure zero downtime in correspondence delivery. - Regulatory & Branding Updates: Implement essential updates driven by evolving state/federal regulations or brand refreshes. What You Will Bring - Experience: 3+ years of dedicated OpenText Exstream development specifically within the health plan or insurance sectors. - Technical Knowledge: Proven experience integrating Exstream with Core Administrative Processing Systems (CAPS), specifically HealthRules Payer. - Data Expertise: Proficiency in XML and flat-file data mapping and transformation. - Domain Expertise: Deep familiarity with commercial health plan document types (ID cards, group statements, regulatory notices, etc.). - Compliance Awareness: A solid understanding of health plan regulatory requirements (e.g., ERISA, state insurance codes) is highly preferred. - Channel Versatility: Experience with multi-channel delivery (print, email, and member portals) is a plus. Part Time role - must be willing to work PST hours, must have health plan experience This position is 100% remote.

HJ Staffing is seeking a Director of Claims and Encounters to provide strategic leadership, fiscal accountability, and operational excellence. This executive role is responsible for directing Claims Operations for Commercial/ASO, Medicare, and Medicaid products. You will lead the Encounters Resolution team to ensure completeness and maximize Medicaid rate setting, driving operational strategy through accurate, timely, and efficient delivery. What You Will Do - Strategic Leadership: Translate strategic goals into specific operating and resource plans. Drive the deployment of Auto-Adjudication methodologies and Robotic Process Automation (RPA/Bots). - Operational Excellence: Oversee workforce planning, process improvement, and staff development for department managers and supervisors. - Compliance & Quality: Ensure regulatory compliance across all areas, specifically driving NM Medicaid compliance for encounter metrics and Turnaround Times (TATs). - Financial Stewardship: Monitor department budgets, manage monthly variance reporting, and maximize Medicaid rate-setting through encounter resolution. - Technical Innovation: Partner with technical SMEs to enhance automation, innovation, and process simplification. Leverage BI tools and data visualization (Tableau) to provide decision support. - Vendor Management: Manage key vendors to validate contract compliance on claims transactions and encounter acceptance measures. - Cross-Functional Collaboration: Support the resolution of complex benefit and provider process issues, collaborating with Configuration, IS, Enrollment, and Member Services. What You Will Bring - Education: Bachelor’s degree in Finance, Business, Healthcare, or a related field (MBA preferred). - Experience: 10+ years of healthcare-specific operational leadership with a focus on Health Plan Claims Operations. - Leadership: 5+ years of experience leading within a complex, highly matrixed function. - Industry Knowledge: Deep understanding of Health Care industry operations, delivery models, and revenue models. - Technical Plus: Experience with Jiva and HRP is highly preferred. You Will Be Successful If: - You have a proven track record of navigating and influencing within highly matrixed environments. - You are an expert at diagnosing and resolving complex problems through a systems-thinking approach. - You can effectively educate employees and transfer knowledge to improve functional effectiveness. - You are skilled at communicating complex ideas and data-driven outcomes to various executive audiences. Important Details - Residency Requirement: Candidates must reside in one of the following states: NM, CA, IL, ND, NY, OH, WA, or WY. - Industry Requirement: Previous experience within a Health Plan or Managed Care Organization is required. - Citizenship: Candidates must be a US Citizen or Green Card holder.

HJ Staffing is seeking a visionary Solutions Architect to bridge the gap between business needs and IT capabilities. In this role, you will design and analyze technology solutions that address complex healthcare business challenges, ensuring they deliver measurable value through robust architecture and modern cloud integrations. What You Will Do - Architectural Design: Analyze and design end-to-end solutions, including data integrations, application components, and detailed technology specifications for network, compute, and storage. - Cloud & Hybrid Infrastructure: Define deployment configurations for on-premises and cloud-based systems (AWS, Azure, or Google Cloud). - Legacy Transformation: Lead strategic migrations from legacy systems to modern, scalable solutions while identifying and eliminating technical debt. - Integrations Mastery: Capture and lead complex data integrations using HL7, FTP, and APIs to ensure seamless interoperability. - Cross-Functional Collaboration: Engage face-to-face with business partners, clients, and IT teams to develop budgets, timelines, and technical blueprints. - Solution Integrity: Work across multiple teams to ensure security, performance, maintainability, scalability, and reliability are embedded in every solution. - Vendor Integration: Partner with external vendors to integrate their products and services into the proposed architectural ecosystem. What You Will Bring - Experience: 10+ years in application support and deployment; 5+ years specifically focused on healthcare data integration is highly preferred. - Education: Bachelor’s degree or 6 years of equivalent professional experience. - Industry Context: Direct experience within a Health Plan or Managed Care Organization is required. - Technical Mastery: Proficiency in system modeling and diagramming tools; experience architecting highly available systems with load balancing and horizontal scalability. - Compliance: Strong understanding of HIPAA, PHI, and PCI compliance standards. - Preferred Tools: Hands-on experience with Jiva and HRP is a significant advantage. You Will Be Successful If: - You are an expert communicator capable of translating business specifications into technical requirements for all levels of management. - You have a deep understanding of healthcare workflows and can align technology with business objectives to maximize ROI. - You are a lifelong learner who quickly adapts to new technologies and emerging cloud frameworks. - You thrive in a collaborative, fast-paced environment where you balance innovation with regulatory constraints. Important Details - Residency Requirement: Candidates must currently reside in one of the following states: NM, CA, IL, ND, NY, OH, WA, or WY. - Remote Status: This position is 100% remote. - Citizenship: Candidates must be a US Citizen or Green Card holder

We are seeking an Advisor Solution Architect to lead the design, implementation, and oversight of secure, scalable, and compliant MMIS (Medicaid Management Information System) solutions. This is a high-impact, strategic role that bridges the gap between business objectives, cutting-edge technology, and rigorous quality standards. You will ensure our Medicaid systems don't just "work"—but excel in performance, security, and federal regulatory compliance. What You Will Do - Modernize & Strategize: Lead the design and modernization of MMIS solutions in alignment with CMS MITA guidelines and enterprise architecture best practices. - Cloud Leadership: Develop and execute AWS cloud migration strategies, prioritizing scalability, reliability, and cost efficiency. - Infrastructure as Code: Architect and deploy AWS infrastructure using Terraform, CloudFormation, or AWS CDK, while maintaining robust CI/CD pipelines. - Security & Compliance: Ensure total adherence to HIPAA and MARS-E standards. Implement AWS security best practices (IAM, VPC, encryption) and lead incident response and vulnerability management. - Quality Oversight: Establish QA procedures, conduct performance audits, and drive continuous improvement based on stakeholder feedback and quality data. - Collaborate & Mentor: Act as the technical bridge between state agencies, vendors, and internal teams, fostering a culture of innovation and mentoring junior staff. What You Will Bring - Experience: 5+ years in Enterprise or Solution Architecture, with direct experience in MMIS/Medicaid. - Cloud Mastery: 3+ years of hands-on AWS experience (EC2, Lambda, S3, RDS, API Gateway). - Technical Toolkit: Proficiency with DevOps tools (Kubernetes, Docker, Jenkins) and architectural modeling tools (TOGAF, ArchiMate). - Compliance Knowledge: Deep understanding of CMS MITA, HIPAA, and MARS-E. - Education: Bachelor’s or Master’s degree in Computer Science, Health Management, or a related field. You Will Be Successful If: - You possess the business acumen to translate complex regulatory requirements into actionable technical solutions. - You are a strategic thinker who thrives on performance optimization and system integration. - You are an expert communicator capable of engaging high-level stakeholders and state agencies with confidence. Preferred Certifications - AWS Certified Solutions Architect (Associate or Professional) - AWS Certified DevOps Engineer - Security Certifications (CISSP, CISM, etc.) - Quality Management (ISO, Six Sigma)

We are seeking a highly skilled Professional Application Designer to design, develop, and support mission-critical application solutions. This role sits at the intersection of complex software engineering and the healthcare industry. You will work across the full software development lifecycle—from initial analysis and architecture to coding, testing, and production support. This is a fully remote position within the Mountain Time Zone. What You Will Do - Design & Develop: Translate complex business requirements into functional technical specifications. Design, code, test, and implement high-performance application programs. - Optimize & Enhance: Perform research on existing systems to recommend improvements; develop and enhance applications to support evolving operational needs. - Architecture & Documentation: Create detailed component-level specifications and technical documentation (design, testing, and system docs). - Testing & Quality: Develop and execute comprehensive test plans (including regression testing), identify defects, and participate in peer code reviews to ensure high standards. - Production Support: Troubleshoot system issues and provide support for production environments to ensure performance and compliance standards are met. What You Will Bring - Experience: 4+ years in application development and batch programming. - Technical Core: Strong proficiency in C programming (memory management, performance optimization, and debugging). - Database & Environment: Experience with SQL (preferably embedded in C), Oracle databases, and hands-on experience in Linux/Unix environments (shell scripting and process management). - Integrations: Familiarity with SOAP/RESTful APIs and JSON. - Tools: Proficiency with Git or TFS, and IDEs such as Visual Studio Code. - Healthcare Expertise: (Preferred) Knowledge of Medicaid, HIPAA, and PHI compliance, as well as experience with claims adjudication processes. - Education: Bachelor’s degree in Computer Science, Software Engineering, or a related field (or equivalent professional experience). You Will Be Successful If... - You are a proactive problem-solver who can propose alternative technical approaches when needed. - You maintain high standards for code quality and documentation. - You can manage multiple priorities in a fast-paced environment. - You collaborate effectively with cross-functional teams while remaining productive independently. Bonus Points - Portfolio: Candidates who can provide a portfolio or samples of past work to showcase their design and coding methodology will be prioritized

We are looking for an experienced UM Medical Director to lead the clinical integrity of our utilization management function. This physician leader will focus specifically on inpatient and post-acute care reviews, ensuring timely and appropriate care determinations for our Medicare Advantage members. Reporting to the Chief Medical Officer, you will evaluate medical necessity for hospital admissions, continued stays, and post-acute services (SNF, IRF, LTACH, and Home Health), ensuring all decisions align with CMS regulations and evidence-based practices. What You Will Do - Utilization Review: Conduct clinical reviews for inpatient admissions and post-acute settings using evidence-based guidelines (MCG, InterQual) and CMS criteria. - Complex Case Management: Serve as the primary physician reviewer for escalated or complex cases requiring high-level medical judgment. - Peer-to-Peer Consultation: Engage in peer-to-peer discussions with attending physicians to clarify clinical documentation and support the appropriate level of care. - Strategic Collaboration: Partner with care management teams to identify utilization trends and develop interventions to reduce unnecessary admissions or extended stays. - Compliance & Documentation: Ensure all decisions are documented in strict accordance with NCQA, CMS, and organizational standards. - Quality Improvement: Contribute expertise to initiatives focused on readmission reduction and transitions of care. You Will Be Successful If - Expertise in Criteria: You possess extensive knowledge of MCG guidelines and their application in clinical decision-making. - Collaborative Mindset: You excel at working within a matrixed organization and can build relationships at all levels. - Analytical Prowess: You have strong problem-solving skills and the ability to explain complex clinical information clearly. - Integrity: You maintain the highest standards of confidentiality and attention to detail. - Tech Savvy: You are comfortable with medical management systems and advanced MS Office products. What You Will Bring - Licensure: M.D. or D.O. in good standing in your state of residence. - Clinical Background: Minimum of 5 years of clinical experience. - Managed Care Experience: At least 3 years in a Utilization Management or medical leadership role within a health plan setting. - MA Knowledge: Strong experience with Medicare Advantage case reviews and CMS coverage criteria. - Preferred: MPH, MBA, or MHA; Certification by the ABQAURP.

Role Description We are seeking a hungry, relationship-driven sales professional who thrives on opening doors, building trust, and closing deals. This is a commission-only role designed for someone who wants flexibility, autonomy, and uncapped earning potential. If you can bring in business, you will be rewarded—plain and simple. This role is ideal for: - Experienced sales professionals - Former staffing or recruiting sales reps - Consultants, account executives, or relationship builders - Individuals with strong local or regional networks What You’ll Do: - Identify and pursue new business opportunities in Texas - Build relationships with decision-makers (HR, Procurement, Operations, Department Heads) - Introduce staffing and workforce solutions aligned to client needs - Set meetings, present capabilities, and close new accounts - Collaborate with leadership to align sales strategy with awarded contracts - Maintain accurate activity and pipeline tracking Qualifications - Proven ability to generate leads and close business - Confidence speaking with executives and decision-makers - Strong communication and follow-up skills - Self-motivated, disciplined, and results-focused - Comfortable working independently without micromanagement - Prior experience in staffing, workforce services, B2B sales, or government contracting preferred but not required Compensation Structure - Commission-only - Paid per closed deal and/or ongoing account revenue - Opportunity to build recurring income from retained clients - Clear commission terms provided upfront - High performers can transition into: - Hybrid base + commission - Account leadership roles - Long-term strategic partnerships Why This Role Works - No cap on earnings - Flexible schedule - Strong service offering with real demand - Leadership support without bureaucracy - Opportunity to grow with the company

• Lead the design of MMIS solutions leveraging enterprise architecture best practices and modular strategies. • Architect and deploy AWS cloud infrastructure using Infrastructure as Code (CloudFormation, Terraform, AWS CDK). • Implement HIPAA and MARS-E standards managing robust incident response capabilities with CloudTrail and SIEM. • Automate deployments via CI/CD pipelines and analyze system data to optimize resource utilization and performance. • Lead cross-functional teams and mentor staff to foster a culture of excellence and quality standards.