Medical Management Specialist – Non-Clinical

Job not on LinkedIn

🔥 13 hours ago

🇺🇸 United States – Remote

💵 $19 / hour

⏳ Contract/Temporary

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Professional Management Enterprises (PME)

WebsiteLinkedInAll Job Openings

51 - 200 employees

🏥 Healthcare

📦 Logistics

🎖️ Defense

Healthcare • Logistics • Defense

Professional Management Enterprises (PME) is a multifaceted professional service and personnel staffing company established in 2006. As a Minority and Service Disabled Veteran Owned Business, PME operates in multiple states, partnering with major corporations such as Humana, KPMG, Ernst and Young, Anthem, and HP. The company specializes in staffing, recruiting, and providing services across various sectors, including healthcare, information technology, and administrative support. PME is a key service provider for the Department of Defense and other Federal Government clients, and it leverages its expertise in healthcare, managed care, IT, and human capital services to deliver flexible and high-performing solutions.

📋 Description

• Execute case management activities, including telephonic member screening, care planning, care plan implementation, service coordination, monitoring and follow-up, reassessment, case conferencing, crisis intervention, and case closure • Provide non-clinical support to the medical management or operations area • Review case records and gather clinical data to determine the proper department or area for case assignment • Receive inbound member case management calls and triage member needs via screening • Provide community and other resources to members • Make appropriate member referrals to clinical case managers • Return voicemail calls received on the case management line • Monitor and manage the case management inbound phone queue • Provide information regarding in-network providers or general program information • Assist with complex cases and act as a liaison between Case Management and other internal departments • Maintain and update tracking databases • Prepare reports and document all actions • Exclude utilization management review activities and other clinical roles requiring interpretation of clinical information

🎯 Requirements

• High School Diploma or equivalent required • Minimum of 1 year of relevant experience in managed care, Medicaid/Medicare, or a related field preferred • Strong organizational and communication skills • Strong computer skills are a must • Must reside within 50 miles of Indianapolis, Indiana • Must be available Monday-Friday, 8 am-5 pm