To submit an application for employment, please complete the information below. Please note: only the information marked with a red asterisk (*) is required.

Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department at 304-368-0288.

Applicant Information

*Position:	General Organ Transplant Program Surveyor-Travel Required Project Manager Registered Nurse/Healthcare Specialist RN Quality Assurance Analyst Project Director Medical Facilities Surveyor - Casual Employment-Travel Required Lead Claims Data Analyst Medical Claims Audit Specialist- RN RN - LTC Medical Facilities Surveyor–Remote/Casual Employment-Travel Required Pharmacy Claims Audit Specialist - Remote/Casual Employment - Travel Required Primary Medical Record Analyst/Medical Records Coder – Remote/Casual Employment
Name
*First:		Middle:		*Last:
Contact Information
Address1:
Address2:
City:		*State:	AL AK AR AZ CA CO CT DC DE FL GA HI ID IA IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VT WA WI WV WY	Zip:
*Phone:		Cell:		*Email:
*Are you legally eligible for employment in the United States?        YesNo

Referral Source

Employee Referral HMS Website Advertisement Monster.com WorkForce / Unemployment Office (State) School Job Fair Other

Record of Conviction

*Have you ever been convicted of a crime other than minor traffic offenses?        YesNo If yes, please provide date(s), location, and details: A conviction will not necessarily automatically disqualify you for employment. Rather, factors such as age and date of conviction, seriousness and nature of the crime, and rehabilitation will be considered.

Resume and Cover Letter

*Please upload your resume and a cover letter using one of the following formats: DOC, DOCX, RTF, PDF, TXT Click here to add a resume/cover letter

Affirmative Action: Voluntary Self Identification

Healthcare Management Solutions, LLC (HMS) is an Equal Opportunity Employer. HMS does not discriminate in employment on account of race, color, religion, national origin, citizenship status, ancestry, age, sex, sexual orientation, marital status, physical or mental disability, veteran status, or any other similarly protected status. We also comply with all applicable laws governing employment practices and do not discriminate on the basis of any unlawful criteria. As required by law, we must record certain information to be made a part of our Affirmative Action Program. Applicants for employment are invited to participate in the Affirmative Action Program by completing this applicant data survey. Providing this information is STRICTLY VOLUNTARY. Refusal to provide this information will have no bearing on your application and will not subject you to any adverse treatment. Please be advised that this survey is not part of your official application for employment. The information will be used and kept confidential in accordance with applicable laws and regulations. EEO Race/Ethnic Self-Identification Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race. White (Not Hispanic or Latino) - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. Black or African American (Not Hispanic or Latino) - A person having origins in any of the black racial groups of Africa. Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) - A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands. Asian (Not Hispanic or Latino) - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. American Indian or Alaska Native (Not Hispanic or Latino) - A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment. Two or More Races (Not Hispanic or Latino) - All persons who identify with more than one of the above five races. Do not wish to identify - All persons not wishing to self-identify race/ethnicity. Veteran Status Information Please check/select all the apply: Veteran of the Vietnam-Era - A person who: (i) served on active duty in the U.S. military, ground, naval or air service for a period of more than 180 days, and who was discharged or released there from with other than a dishonorable discharge, if any part of such active duty was performed: (A) in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or (B) between August 5, 1964, and May 7, 1975, in all other cases; or (ii) was discharged or released from active duty in the U.S. military, ground, naval or air service for a service connected disability if any part of such active duty was performed during the times and places specified under (i). Recently Separated Veteran - Any veteran who served on active duty in the U.S. military, ground, naval or air service during the one year period beginning on the date of such veteran's discharge or release from active duty. Other Protected Veteran - Includes any veteran who served on active duty in the U.S. military, ground, naval or air service in a war, campaign or expedition in which a campaign badge has been authorized under laws administered by the Department of Defense. To identify campaigns or expeditions that may meet these criteria, you may visit the following website: http://www.opm.gov/staffingportal/vgmedal2.asp. Armed Forces Service Medal Veteran - Includes any veteran who, while serving on active duty in the Armed Forces, participated in a United States military operation for which a service medal was awarded pursuant to Executive Order 12985. None of the above apply to me - Includes any individual who does not fall into any of the above categories.

Applicant Statement

Please read carefully before accepting. I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for HMS to hire me. If I am hired, I understand that either HMS or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of HMS has the authority to make any assurance to the contrary. I attest that I have given to HMS true and complete information on this application. No requested information has been concealed. I authorize HMS to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal. *I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.