Professional Management Enterprises

Role Description We are seeking a dynamic and experienced LTSS Service Coordinator - RN Clinician to join our team. In this role, you will be responsible for the overall management of members' cases, providing supervision and direction to non-RN clinicians while ensuring compliance with applicable state laws and contracts. You will conduct clinical assessments, develop individual care plans, and coordinate care to meet the diverse needs of our members. - Manage members' cases within the scope of licensure, providing supervision and direction to non-RN clinicians. - Conduct telephonic or face-to-face clinical assessments to identify and evaluate members' needs, including physical health, behavioral health, social services, and long-term services and supports. - Identify members at high risk for complications and coordinate care in collaboration with the health care team. - Develop, monitor, evaluate, and revise individualized care plans to optimize member health across the care continuum. - Establish short- and long-term goals in collaboration with members, caregivers, family, and physicians. - Identify members who would benefit from alternative levels of care or waiver programs. - Assist in the implementation of member care plans by facilitating authorizations/referrals for services. - Interface with Medical Directors, Physician Advisors, and Inter-Disciplinary Teams on care management treatment plans. - Direct and/or supervise the work of non-RN clinicians, ensuring tasks are assigned appropriately and performance is reviewed regularly. Qualifications - Registered Nurse (RN) with a minimum of 3 years of experience in working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management, or similar role. - Current, unrestricted RN license in Indiana. - MA/MS in Health/Nursing preferred. - State-specified certification based on state law and/or contract may be required. - Training, expertise, and experience in providing case management and care coordination services for individuals, including specialized populations such as older adults and/or individuals with physical or developmental disabilities and/or individuals determined to have a serious mental illness (SMI). - Strong communication, organizational, and problem-solving skills. - Ability to work effectively in a collaborative team environment. Requirements - This position does require ~ 50% travel (mileage is reimbursable), all other work is remote. - Hours: Monday - Friday 8am-5pm - Pay: $43.50/hr ($90,480/yr) Benefits - Health, dental, vision and supplemental insurance - 401k - 80 hours of PTO - 10 paid holidays - Reimbursable mileage

Description We are looking for a behavioral health case manager to join our team. This is a full-time, Monday - Friday, 8am-5pm role. This position is completely remote but does require an active unrestricted license in Indiana and Indiana residency. Position comes with medical, dental, and vision insurance. Pay: $73,000-$80,000 Job Responsibilities · Uses appropriate screening criteria knowledge and clinical judgment to assess member needs. · Conducts assessments to identify individual needs and develops care plan to address objectives and goals as identified during assessment. · Monitors and evaluates effectiveness of care plan and modifies plan as needed. · Supports member access to appropriate quality and cost-effective care. · Coordinates with internal and external resources to meet identified needs of the members and collaborates with providers. Requirements Job Requirements · Requires MA/MS in social work, counseling, or a related behavioral health field, and minimum of 3 years clinical experience in social work counseling with broad range of experience with complex psychiatric and substance abuse or substance abuse disorder treatment. Or any combination of education and experience which would provide an equivalent background. · Current active unrestricted license such as RN, LCSW (as applicable by state law and scope of practice), LMHC, LICSW, LPC (as allowed by applicable state laws) LMFT o Or Clinical Psychologist to practice as a health professional within the scope of licensure in applicable states or territory of the United States required. · Experience in case management and telephonic and/or in person coaching with members with a broad range of complex psychiatric/substance abuse and/or medical disorders preferred.

Description Behavioral Health – Utilization Management - Clinical Intake Clinician We’re looking for a Clinical Intake Clinician who can combine clinical expertise with strong communication skills to connect members with the right level of care. This role is mostly provider-facing, with some member interaction to gather information and guide care decisions. Hours: M-F 8am-5pm 10 paid holidays 80 hours PTO Pay: $79,000-$83,000/yr What You’ll Do: - Review and manage behavioral health benefits for psychiatric and substance use treatment (inpatient, outpatient, and facility-based) through phone and written reviews. - Use screening criteria, clinical judgment, and UM guidelines to ensure members get medically necessary, cost-effective care. - Refer cases to Peer Reviewers when needed. - Coordinate and monitor care plans to promote quality outcomes and effective use of benefits and community resources. - Support BH Care Managers and handle complex cases. - Contribute to team projects and department initiatives. What You’ll Bring: - Strong clinical knowledge in behavioral health. - Ability to assess needs, plan care, and collaborate with providers. - Commitment to quality care and cost-effective solutions. Requirements What You’ll Need - Master’s degree in social work, counseling, or a related behavioral health field or a degree in nursing. - At least 3 years of experience in facility-based and/or outpatient psychiatric or substance use treatment (or equivalent combination of education and experience). - Current, active, unrestricted license in the U.S. such as RN, LCSW, LMHC, LMFT, or Clinical Psychologist. - Prior experience in case management/utilization management, including complex psychiatric and substance use cases. - Managed care experience required. - Strong oral, written, and interpersonal communication skills, plus problem-solving, facilitation, and analytical abilities.

Description REMOTE || Sunday-Wednesday & Fridays 9:00pm-5:30am (Overnight) Pay: $17/hr. Position Overview We are seeking a detail-oriented, customer-focused, and self-driven Transportation Dispatcher to join our overnight team. In this role, you will coordinate and manage transportation services, ensuring efficient trip scheduling, accurate data entry, and high-quality service for clients and providers. This is a fast-paced, remote position (excluding the 4 weeks of in-office training) that requires strong communication, organization, and problem-solving skills. About WellTrans WellTrans is dedicated to eliminating transportation as a barrier to good health by ensuring members can reliably reach the care they need. With over 20 years of experience serving the Medicaid and Medicare community, the company prioritizes safe, secure, and on-time transportation for every trip. WellTrans works closely with members to understand and meet their transportation needs while supporting a network of providers that offer a wide range of accommodations, including wheelchair-accessible vehicles, bus service, and overnight trips. By coordinating the logistics, WellTrans allows members to focus on their health while receiving dependable service from a team that is deeply connected to the communities it serves. WellTrans is a Certified Minority and Disabled Veteran owned business and an equal opportunity employer. Key Responsibilities - Schedule, coordinate, route, and dispatch trips across a diverse network of transportation providers - Prioritizing overnight tasks to ensure daily completion - Manage trip administration for providers and drivers, including mileage reimbursement programs - Collaborate with transportation providers and healthcare facilities to resolve transportation service issues - Assign reservations to providers to maximize efficiency and meet client demand - Maintain consistent, professional communication with transportation providers and day-time team members and leaders - Ensure accurate and timely data entry for all trips - Support additional operational tasks and responsibilities as assigned Requirements Core Competencies & Qualifications - Strong analytical and problem-solving skills - Basic understanding of customer service skills - Proficient understanding of general technology use - Able to fully work the shift with professionalism throughout all hours - Excellent verbal and written communication - Customer-focused mindset with a commitment to service excellence - Ability to work effectively with diverse individuals and teams - General understanding of transportation systems Education & Experience - High school diploma or GED required - 1–2 years of customer service experience in a high-volume, inbound call center preferred - 1–2 years of dispatching, routing, or scheduling experience preferred - Prior call center experience strongly preferred - Knowledge of transit systems is a plus - Familiarity with health insurance guidelines and covered services is a plus Skills & Abilities - Exceptional customer service and phone communication skills - Proficiency in Microsoft Word, Teams, Excel, and Outlook - Strong attention to detail and organizational skills - Ability to work independently and collaboratively in a team environment - Comfortable handling high call volumes while maintaining accuracy and professionalism

Description BKG Enterprises is seeking Medical Management Specialist to join our team! This is a work-from home opportunity! - Call Center - Monday - Friday 8am-5pm -Training pay: $18.50/hr after training pay $19.25/hr -Medical, dental, and vision insurance offered -Supplemental insurace -80 hours of PTO after 90 days -10 paid holidays Responsible for providing non-clinical support to medical management operations calls, which includes handling the most complex file reviews and inquiries from members and providers. Primary duties may include but are not limited to: - Gathers clinical information regarding case and determines appropriate area to refer or assign case (utilization management, case management, QI, Med Review). - Conducts initial review of files to determine appropriate action required. - Maintains and updates tracking databases. - Prepares reports and documents all actions. - Responds to requests, calls or correspondence within scope. - Provides general program information to members and providers as requested. - May review and assist with cases. - May collaborate with external community-based organizations to facilitate and coordinate care under the direction of an RN Case Manager. - Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information. - Acts as liaison between medical management operations and other internal departments to support ease of administration of medical benefits. Provides mentoring and work direction to lower-level associates. - Requirements - Requires a high school diploma and a minimum of 5 years administrative and customer service experience; or any combination of education and experience which would provide an equivalent background. Knowledge of managed care or Medicaid/Medicare concepts strongly preferred. - Position requires strong customer service/call center skills