Professional Management Enterprises (PME)

Account Manager

• Develop and maintain positive relationships with the provider community by conducting regular on-site and/or virtual/digital visits.
• Communicate administrative and programmatic changes to providers.
• Facilitate education and resolve provider issues promptly.
• Serve as a knowledge and resource expert regarding provider issues impacting provider satisfaction and network retention.
• Research, analyze, and coordinate prompt resolutions to complex provider issues and appeals through direct contact with providers and internal matrixed partners.
• Collaborate within a cohort of internal matrix partners to triage issues and submit work requests.
• Manage a portfolio of providers within a defined cohort.
• Coordinate Joint Operation Committees (JOC) with provider groups, driving meetings to discuss issues and changes.
• Assist with Annual Provider Satisfaction Surveys, implement required corrective action plans, and monitor educational activities, contract questions, and non-routine claim issues.
• Coordinate communications on administrative and medical policy, reimbursement, and provider utilization patterns.
• Conduct proactive outreach to support the understanding of managed care policies and procedures, as well as various initiatives and programs.
• Participate in external Provider Townhalls/Seminars and attend State Association conferences (e.g., MGMA, AFP, AAP, HFMA).
• Identify and report on provider utilization patterns that impact the quality of service delivery.
• Research issues that may impact future provider contract negotiations or jeopardize network retention.

Medicaid Provider Relationship Account Manager

Manager

• Manage a caseload of pregnant members, providing telephonic support and care coordination
• Educate and guide members through pregnancy, delivery, and postpartum care.
• Conduct comprehensive assessments to identify individual needs and develop care plans.
• Coordinate medical appointments, referrals, and follow-up care across providers and community resources.
• Monitor care plans, evaluate progress, and make adjustments as needed.
• Ensure members have access to appropriate services based on their health needs.
• Maintain accurate documentation in insurance systems and adhere to compliance standards.
• Collaborate with physicians, social workers, and other care team members to optimize member outcomes.

OB RN Case Manager

Call Center Representative

• Answer and direct incoming calls in a timely and professional manner.
• Help ensure calls are routed to the correct department or representative to maintain smooth daily operations.
• Confirm each caller’s identity using approved verification steps before discussing any information.
• Record the details and schedule a follow-up for non-urgent requests.
• Transfer the caller immediately for urgent or same-day requests.
• Direct the caller to the correct team for real-time ride updates on 'Where’s My Ride' inquiries.
• Forward routing questions for recurring appointments to the routing department for assistance.
• Accurately record all call details and outcomes in the system.
• Maintain confidentiality and follow all privacy and compliance standards at all times.

Call Center Operator, Part Time

Customer Support

• Responsible for verifying member eligibility
• Providing outreach for members
• Documenting requests with vendors and members
• Responsible for ensuring fulfillment and delivery to members
• Tracking daily interactions via telephone and internet and updating tracking accordingly
• be an integral member of our food scarcity program

Member Support Specialist

Operations

Title: LTSS Provider Data & Operations Analyst Location: Remote within Indiana 25% Travel Hours: Standard business hours M-F 8am-5pm Pay: $95,000 - $104,000 About the Role As the LTSS Provider Data & Operations Analyst , you’ll be the go-to expert for ensuring the accuracy, integrity, and optimization of provider data that powers our Long-Term Services and Supports (LTSS) network. Your work will directly impact how providers are onboarded, supported, and connected to the individuals they serve. You’ll analyze complex datasets, resolve data issues, improve processes, and work closely with both internal teams and external partners to ensure smooth operations and regulatory compliance. This is a role for someone who is detail-oriented, analytical, and collaborative — with the drive to turn data into actionable insights that improve outcomes. What You’ll Do Analyze LTSS provider data to track performance, identify trends, and create actionable reports for leadership and partners. Conduct regular audits to identify data discrepancies, assess downstream impacts, and implement corrections. Build dashboards and visual tools to support decision-making and monitor provider network health. Serve as the Subject Matter Expert for LTSS provider data load requirements, ensuring accuracy and consistency across systems. Partner with LTSS Provider Relations leadership to make provider data updates and resolve related issues. Maintain alignment between Facets, SPS, and other downstream systems to prevent data conflicts. Manage and resolve provider data tickets submitted by the local LTSS Provider Relations team. Collaborate with operations teams to improve provider data workflows and service delivery processes. Work closely with Provider Data Solutions (PDS) teams to align policies, procedures, and desktop processes. Lead provider data review meetings to discuss audit results, upcoming changes, roster submissions, and DART loads.

Medicaid Provider Relationship Account Manager

OB RN Case Manager

Call Center Operator, Part Time

Member Support Specialist

Provider Data and Operations Analyst