Professional Management Enterprises (PME)

General

• Provides non-clinical support to medical management operations calls
• Gathers clinical information regarding cases
• 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
• Acts as liaison between medical management operations and other internal departments

Medical Management Specialist

Data Analyst

• Analyze Medicaid business reporting needs to determine the most effective means of meeting those needs
• Work with programming staff to ensure requirements are incorporated into system design and testing
• Act as a liaison with software users to address questions and issues
• Maintain knowledge of systems capabilities and Medicaid business operations strongly preferred
• Completes Medicaid regulatory reporting, as needed
• Use geo-access software to identify gaps in provider/member access
• Responsible for provider directory auditing related to Medicaid services
• Work with the team and demonstrate strong collaboration skills
• Solve complex Medicaid data issues effectively

Medical Management Specialist

Medicaid Data Analyst