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Supervision Exercised. Required Knowledge, Skills, and Abilities. Requires the following with or without reasonable accommodations:. Minimum Qualifications.

Experience is required in GIS, computer-aided drafting or related engineer training. Must be able to effectively communicate orally in person and over the telephone and in writing using electronic devices and handwritten in English with other employees, businesses and community members.

Must be insurable and maintain insurability. Note: Bishop is looking to hire two people for this position for full-time employment. They are willing to work around an active CET student’s in-person class schedule. Experienced Survey Instrument Person for construction layout and other engineering and land surveying duties. Our Mission. The mission of the Iowa DOT is safest, smartest, made to last.

Shifts: Days, Monday through Friday. The Design Bureau is looking to hire a Design Technician that will be part of a team designing highway improvement projects and construction plans that will be used to enhance the state and national transportation systems in Iowa. If you are self-motivated, enjoy spending time outdoors, and have a passion for serving community we invite you to join the City of Hiawatha Public Works Team.

Position is responsible for performing a wide variety of skilled and semi-skilled activities related to maintaining and repairing streets, storm sewers, sanitation sewer collection system and signage. Duties include but are not limited to: clean and repair storm and sanitary sewers including sewer lines, manholes, intakes and related structures. Provide general cleanup and housekeeping of Public Works Facilities.

Install, repair and maintain traffic signs and barricades; maintain inventory of signs and supplies; and identify locations of signs and posts. Clean city roadways and right-of-ways by mowing grass along roadways; maintaining, trimming and removing trees and landscaped areas.

Perform routine maintenance on city equipment and vehicles including: lubricating, washing, making minor mechanical adjustments and other preventative maintenance. Load and unload heavy objects and materials as needed. Construct and repair City-owned buildings, fences, and other facilities using manual labor and equipment as needed. Perform snow removal activities by plowing, hauling, and loading snow, hand shoveling, and applying abrasives and chemicals to streets.

Repair streets and sidewalk, filling potholes, sealing cracks, and performing necessary clean-up activities. Assist other City departments and performs other duties as directed. Must be available to respond in emergencies or unusual situations outside of the normally assigned work periods. Pre-employment physical and drug test required.

Minimum High School diploma or GED Certificate and one year of construction, maintenance, equipment operation or related experience; or an equivalent combination of education and experience sufficient to successfully perform the essential duties of the just such as those listed above.

Professional Land Surveyor. Location: Pleasant Hill, Iowa. Stubbs Engineering is 3rd generation family-owned business in Pleasant Hill, Iowa. The company grew and expanded into developing single-family, multi-family, and commercial subdivisions. These developments have become flourishing neighborhoods and communities. The 3rd generation has brought 3 engineers to the business. Stubbs Engineering strives to offer innovative, cost-effective civil design solutions.

Job Description:. Stubbs Engineering is seeking to hire a Professional Land Surveyor to join our team. The licensed land surveyor will need to do a multitude of surveying duties. Duties include: boundary surveys, ALTA Land Title Surveys, subdivisions, topographic surveys, industrial quantities surveys and construction staking.

Job Type: Full-time. Work Location: One location. Applicants must meet at least one of the following minimum requirements to qualify for positions in this job classification: 1 Graduation from high school or GED equivalent , and experience equal to six years of full-time work in design drafting, cartography, photogrammetry, engineering survey, soils survey, land survey, or construction inspection.

Design GroupLLC. Because of additional opportunities with our existing client base, as well as potential new markets, SDGroup is seeking a structural Building Information Modeler, Technician or Designer to join our firm. Designers and technicians work under the direction of our lead engineers on a variety of projects and project types utilizing structural steel, concrete, masonry, and wood materials.

Our clients consist of architectural firms, other design professionals, contractors, municipalities, as well as industrial, educational, and governmental facility owners. The right candidate would also be considered for the BIM Leader position within the firm.

If interested, please indicate so on your application. Other geographical areas where we provide our services may also be considered. The City of Marshalltown has both seasonal summer and full-time openings in the following areas:. Full Time:. Civil Engineering Assistant II. Seasonal Summer :. This position involves adapting drafting design knowledge and experience with a focus on the exterior building enclosure. Essential Functions:.

Minimum Physical Requirements:. Regular site visits to conduct construction observation under varying climate conditions. Applicant will encounter exposure to conditions of active construction and walking on uneven ground. Will be required to setup building enclosure commissioning testing equipment. The candidate must be comfortable with climbing ladders and walking roofs while adhering to company and OSHA safety standards, policies, practices and procedures.

Today, as always, Abaci has a deeply held belief that investment in its people is paramount. Paired with a pursuit of improved technology and a stellar reputation for providing robust design and value, these practices have allowed Abaci to maintain relationships with many clients for decades.

As Abaci grows its services and technology, we retain the traditional values that the firm was founded on:. We value the resources of our clients and endeavor to complete projects efficiently and under budget. We value the success of our clients. We value high quality service in every project we undertake.

We value expertise. Abaci staff is highly trained and educated, offering both breadth and depth of professional expertise. We value honesty and integrity. We value a collaborative work environment for our staff, encouraging communication and teamwork. The LSIT will, mentor team members, and manage budgets and profitability. Establish plans to ensure efficiency and quality on land survey projects. Research of land records and deeds. Manage survey crews conducting survey activities, including but not limited to boundary surveys, plat of surveys, and rural subdivisions.

Coordinate with other leaders in the firm to identify and capture new business opportunities. Working towards an Iowa license as a Professional Land Surveyor. Knowledge of local governments and regulations that apply to surveying duties. Valid driver’s license and insured. Must be able to work in all kinds of weather and be able to routinely carry 40 pounds over uneven terrain.

Occasionally lift up to 80 pounds. Enthusiasm for people and drive to bring out their best, fostering a culture of collaboration and accountability.

Ability to mentor and direct team members and identify professional development opportunities. Maintain relationships with clients, government representatives, contractors, vendors, and fringe network associates. Abaci Consulting offers a full suite of benefits to supplement a decidedly competitive salary. Abaci Consulting is in Grimes, Iowa.

Grimes is one of the most youthful and fastest growing cities in Iowa. The City of Grimes is a Central Iowa suburb located northwest of the capital city of Des Moines with ready access to metropolitain amenities. Grimes leadership is dedicated to investing in economic and business projects to maintain quality living with projected community growth. The Des Moines Metropolitan area population is estimated at , This is a full time position. Primary job classification is Engineering Intern.

Applicant must possess high school diploma or GED; and must possess a valid driver’s license. They start at 15 per hour and give raises periodically. Graduation from high school or GED and experience equal to six years of full-time work experience in design drafting, cartography, engineering survey, soils survey, land survey, construction inspection or photogrammetry;. This is a professional path position that provides the opportunity to earn a Professional Surveying License.

This position is available in our West Des Moines Office. Shive-Hattery fosters a team oriented atmosphere and emphasizes unparalleled client services. We offer the opportunity for involvement in a wide variety of surveying, civil engineering, landscape architecture and building projects.

Requirements :. Would also be responsible for :. Status: Full-Time. Salary Day Annual Work Schedule:. Link To: Employee Benefits. This faculty position provides instruction, student advising, and academic program responsibilities for Southeast Tech’s Land Survey Science Program.

Responsibilities include:. We offer an excellent salary and benefits package. Position available for onboarding and training activities in March, , for the school year. Position open until filled. Veenstra and Kimm, Inc. Our engineers, planners, and surveyors have been offering a full complement of services to our clients since the company’s inception.

We have prided ourselves on a high level of commitment to assisting our clients achieve their goals and making their homes a better and safer place. Our employees enjoy a flexible, relaxed work environment from which to work and grow. Access and exposure to a breadth of individuals and project types allow for both professional growth as well as personal growth. Our team works with local communities on a wide range of civil, municipal, and environmental projects.

All qualified candidates are encouraged to apply. Employment selection and related decisions are made without regard to sex, race, age, disability, religion, national origin, sexual orientation, gender identity, or any other protected class. Ingios Geotechnics, Inc. Ingios is seeking qualified applicants for 3 full-time Civil Engineering Technician positions. One position is based in Iowa, one in Minnesota, and one in Tennessee. Ingios Geotechnics is an industry leading geoconstruction engineering firm specializing in the characterization, testing, and construction process control of geo-materials using advanced proprietary testing equipment.

Clients include state departments of transportation, private industrial firms, geomaterial manufacturers, and the electrical power generation industry. Normally 40 hours per week but will vary involving longer workdays at times to meet customer requirements. The applicant must be able to travel and work irregular hours if needed. Overnight travel will be required.

Accurate execution and reporting of test results is critical to meeting the customer’s requirements. The technician will be responsible for use and maintenance of electronically controlled testing equipment requiring basic computer proficiency.

Operation of straight truck and trailer, forklift, and other similar equipment is required to support testing requirements. Ingios is seeking qualified applicants for a Senior Civil Engineering Technician position. The position is based in Iowa but could occasionally involve travel to other mid-west states to support projects.

Our home laboratory facility is located in Lakeville, MN. Once fully trained the technician will at times be working independently on projects and supervising other technical staff. Washington County Engineers Office is looking for a college student pursuing undergraduate Civil or Construction Engineering to assist with construction inspection and basic land surveying.

Other degree focuses will also be considered. Student must be hard working, responsible, punctual, able to follow instructions, and able to work independently. Must have a valid Iowa Driver’s License. This will be a temporary summer position with competitive wages. Some overtime may be required. Applications and resumes may be submitted to engineer co.

If you have questions, please call Application deadline is PM on Friday, April 15, or until filled. Surveying experience a plus.

Strong communication skills plus computer literacy are required. Salary is based on qualifications and experience. Performs basic field and laboratory tests as directed. Exercises selection of test frequency and has the ability to make limited analysis of data. Observe placement.

Product laboratory trial batches. SE3 is a growing civil engineering firm that is committed to great quality and serving the needs of our clients.

As a CADD Technician, you will have an opportunity to work on a variety of public and private sector projects across the company.

SE3 has been involved in many significant transportation projects in northeastern Illinois and has expanded into the Dallas, Austin, St. Louis, Denver, and Kansas City markets. If you are looking to expand your horizons, grow in responsibility, technical ability, and leadership, SE3 is the place for you.

Point of Contact Robert Ellis, Robert. Ellis Iowadot. Location: North Maintenance Garage – Within five 5 months, employees are required to reside within 45 minutes driving time, during normal conditions, from assigned work location. Desired abilities:. Highway Technician responsibilities:. For additional information, please click on this link to view the job description Download PDF reader.

Additional Qualification Requirements. As a Survey Field Intern you will spend the majority of your time working on survey crews with an experienced crew chief.

The emphasis will be on construction staking and get experience with Trimble, Robotic Total Station, and GPS equipment in this internship. This position will require working outdoor conditions for the majority of your day. You must be physically able to navigate rugged terrain for the purpose of performing the duties described above. Students must possess a valid driver’s license and be insurable under the firm’s standard rates.

A check of the candidate’s motor vehicle record will be conducted as part of the on-boarding. This position interacts with staff, land owners, contractors, and subcontractors. Selected candidates will be enrolled in a Civil Engineering Technician, Land Surveying or Survey Technician Degree, or related field, from an accredited post-secondary institution. General coursework in, and completion of, general surveying and AutoCAD drafting are preferred.

Work with a creative and hardworking team, who believe in client satisfaction and building relationships. With over employees and 24 offices in Minnesota, Iowa, North Dakota, North Carolina, and South Carolina, there are always new challenges and career development opportunities available. We’re Social! We thank all applicants in advance for their interest in this position, however, only those selected for an interview will be contacted.

They are a nationwide company. In Iowa, they have offices in:. We are Olsson, a nationally recognized, employee-owned engineering and design firm with a rich history of success.

Simply put, we work to leave the world better than we found it. Our most important asset is our people, and we are dedicated to an environment where we continue to learn, grow, and thrive. This entrepreneurial spirit has made us successful and will keep us successful. The result? Inspired people. Amazing designs. And projects with purpose. A win-win for all. We want to deploy more than 12 survey crews state-wide. As part of a new team, you would:. You may have formal education in surveying.

You may not. What we are looking for is someone with fundamental experience, who is ready to take the step to the next level. Someone who can perform all kinds of land surveying fieldwork with confidence and minimal assistance. Someone who is eager to learn and enjoys being outside. This is primarily a field-work position.

While occasional overnight travel might be required, this will be very minimal. You must be capable of working in rough terrain and inclement weather. We hire survey staff with the intention of providing work throughout the winter months. You must be able to lift pounds. CGA is employee-owned, offering competitive wages and benefits including. Point of Contact Jeremy Harris, Jeremy.

Assistant Survey Party Chief This assistant survey party chief position is on a preliminary survey crew in the survey section within the Design Bureau. The assistant survey party chief performs technical engineering survey work. Typical responsibilities include collecting topographic survey data, performing survey computations, as well as collecting, formatting, and editing electronic field data.

This position requires skills that include excellent communication, , knowledge of electronic data collectors, and knowledge of electronic data collection procedures, some CADD mapping and GNSS operation is required. Applicants must have experience using survey instruments including electronic total stations, global positioning equipment, survey levels, and a thorough understanding of feature and linking codes.

Bentley MicroStation software is used. Travel: In-state overnight travel can be required. Preferred experience. Additional Requirements. For additional information, please click on this link to view the job description. Download PDF reader. We are looking to add a team member to help in our QC department. Looking for someone with basic cad experience that we can train to use our total station for simple layout on our job sites.

We are looking to fill this position over the next few months. A motor vehicle record MVR check is a standard condition of employment. With over employees in Minnesota, Iowa, North Dakota, North Carolina, and South Carolina, there are always new challenges and career development opportunities available. We are committed to the well-being of our employees and their families. No fee will be paid to third parties who submit unsolicited candidates directly to our hiring managers. We have over 70 years of experience serving the Upper Midwest and beyond.

As a Star Tribune Top Workplace, this is a fantastic opportunity to work with a great team of professionals and grow your career! We are looking to add a talented individual who will help foster our mission that All People Should Live in a Safe, Sustainable and Beautiful Community!

We are passionate about using collaboration to lead us to the right solution. A solution that can be planned for and funded. A lasting solution that not only works today but long into the future.

Our expertise offers a fresh, engaging approach to solve multi-faceted problems involving technical, regulatory, and community issues. As a Civil Engineer Intern – Transportation, you will learn practical on-the-job experience and spend the majority of your time working with construction phase activities. Duties may include assisting with construction observation, performing construction staking, performing construction administration duties such as documenting activities, measuring and testing, providing general oversight, and interacting with contractors, sub-contractors, residents and City Staff.

Some internship opportunities may also include working on various reports, completing design calculations, writing specifications, and reviewing shop drawings. Each year we look for variety of experience, education, and ability for our student intern pool. Some positions may be filled with students who have experience depending on the level of complexity a project or client may require.

Company Information:. Our ready-mix plants are strategically located around the metro area, including two portable plants for best access to job sites. This position will primarily be based in Des Moines, IA.

Position Overview. The Quality Control Technician position is responsible for providing inspection, testing services, and documentation of product for plant facilities.

This position is also responsible for evaluating data necessary for adjustments to mix production to ensure compliance for all applications and projects. Key Responsibilities Essential Duties and Functions.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disability to perform the essential functions. Work Requirements.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Work Environment. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Benefits Offered. If you are self-motivated, enjoy spending time outdoors, and have a passion for serving community we invite you to join the City of Hiawatha Engineering Team.

The City of Hiawatha, Iowa is seeking qualified applicant for the full-time position of Engineering Technician. Position shall provide construction observation for projects involving City property including all right-of-way. Duties include but are not limited to daily reporting, quantity tracking for payment, communication with the contractor and design team, documenting project details and conflicts, and being a representative for the City of Hiawatha on project sites.

The Engineering Technician must exercise discretion and independent judgment in the day-to-day activities of the City infrastructure and development. Minimum High School diploma or GED Certificate and minimum two 2 year degree in construction or engineering related field.

This job does not appear on their company “jobs” page, but they are accepting application. This job is not posted on their company website, but they are taking applications. Actalent Services is recruiting a civil engineering technician for a Des Moines area company. Any interested candidates can contact Kevin Simons directly to find out more about the position.

As a technician, you will perform a variety of testing on construction materials such as soils, concrete, masonry, and asphalt. Braun Intertec is a Drug-Free Workplace and requires all new hires to complete a pre-employment drug screen test, criminal background check, and motor vehicle report. Braun Intertec employees are encouraged to expand their skills and certifications through company provided training and mentoring. B raun Intertec strives to ensure that its careers web site is accessible to all.

If you need assistance completing your online application, please email hrhelp braunintertec. As an Equal Opportunity Employer, Braun Intertec is committed to providing reasonable accommodations for qualified individuals with disabilities and disabled veterans.

If you need a reasonable accommodation to assist with your job search or application for employment, please e-mail us at hrhelp braunintertec. In your e-mail, please include a description of the specific accommodation you are requesting as well as the job title and requisition number of the position for which you are applying.

The project work for these roles will be related to a thriving construction season for our clients in these regions. For the right intern or co-op, there will be much to do and much to learn. Full-time college student majoring in civil or construction engineering.

Must have strong work ethic, demonstrated desire to learn from hands-on experiences working in a team. Must possess strong communication skills, ability to work in a team and as an individual contributor; Able to manage activity through competing priorities. Must be reliable – i.

This can be a very client-centric role – must have strong people skills and ability to effectively manage relationships with a wide range of clients, contractors and other project stakeholders. Any prior experience with construction or prior internships in civil engineering or construction engineering is a plus. Any construction materials or. DOT-related certifications a plus. The City of Ankeny is seeking a highly motivated, energetic civil or construction engineering student to complete a summer internship with the City’s Development Engineering Division.

Pre-employment drug screen and background check required. Interested individuals should apply online and attach a detailed cover letter expressing interest, with a resume or other similar document, no later than February 27, All applicants will be considered; however, preference will be given to current students majoring in Civil or Construction Engineering or a related field who have completed their sophomore years or higher.

Candidates should be detail oriented and be able to keep accurate records. Excellent written and verbal communication skills are a must. The ability to multi-task is critical since the candidate may work on several projects at the same time. This individual would be working for Engineering Services based out City Hall. Good experience is desirable but we are also not afraid to train the right person with a great attitude, good communication skills and strong work ethic.

The candidate for this position will primarily work closely with the District 1 Right of Way Land Survey Department and other District staff, performing boundary, topographic, and construction surveys. They will be working with R.

Researching for survey related documentation, including U. Corner Certificates, Deeds, Plats of Survey, Subdivision Plats, and highway plans, from various agencies, may be included. Contact : Allison Smyth allison. We’ve been in business for more than 85 years, serving public and private clients with evidence of our work in nearly 35 states.

Brief Posting Description We are looking for an individual who wants to be part of a team that provides exceptional service to our clients, and we have an immediate opening for a Survey Crew Chief located in Mason City, IA. Responsibilities for this position include: Topographic mapping, boundary surveys, processing field surveys and construction staking, interacting with clients and contractors, and providing Quality Assurance and Quality Control.

This position acts as crew chief for a field survey crew or alone performing surveys for construction, land development, topographic, right-of-way, ALTA and control survey projects; participates in pre-survey planning meetings with project managers, resident project representatives, engineers, and contractor representatives; provides input for evaluation of members of field survey crew; and instructs and trains survey crew in survey and mapping methods, use of equipment, and field safety procedures.

The Crew Chief position gathers field survey data through use of conventional and Global Positioning System GPS methods; sets up, adjusts, maintains and operates surveying equipment, including robotic total station, data collectors, and GPS equipment, in order to measure distances, elevations, and angles; prepares field notes and drawings; and performs field surveying for roadway, railway, bridges, site and land development projects, including installing surveying construction stakes, and locating or establishing vertical and horizontal control, right of way, monuments, corners, boundaries, and property lines.

Research existing record information, including record maps, plans, deeds, easements, and rightof-way documents; and maintains field data records and survey project files. Ellis iowadot. Location: Des Moines North Maintenance Garage – Within five 5 months, employees are required to reside within 45 minutes driving time, during normal conditions, from assigned work location.

Desired Abilities:. Highway Technician Associate responsibility:. Point of Contact David Bare – david. Team lift or mechanical assist recommended for weights over 75 lbs. Additional Requirements : Post offer, pre-employment physical.

Must successfully complete a Federal Highway Administrative approved comprehensive bridge inspection training course required by the National Bridge Inspection Standards prior to appointment or within a period of time designated by the appointing authority. Work Hours: Days, Monday through Thursday, am to pm Travel: The person selected must be willing to travel and be able to climb and work under difficult and potentially hazardous conditions; occasional overnight travel. The Design Bureau is looking to hire a Design Technician Associates that will be part of a team designing highway improvement projects and construction plans that will be used to enhance the state and national transportation systems in Iowa.

Point of Contact Jim Scott, Jim. Scott iowadot. Location: Grimes Maintenance Garage – Within five 5 months, employees are required to reside within 45 minutes driving time, during normal conditions, from assigned work location. We are seeking an entry level Land Surveying Technician to join our team in all three offices. Position involves assisting a Survey Crew Chief with surveying field work, minor computer aided drafting and general project assistance.

The successful applicant will be a self-starter, motivated to meet internal deadlines and possess the ability to clearly communicate with other team members. Must have basic math skills, computer skills and the ability to work well with others in a team environment.

Wages are commensurate with experience and skill set. If you meet these qualifications and are ready for an exciting, challenging and rewarding summer please apply at www. Position involves assisting a Professional Land Surveyor with surveying field work, drafting surveys, legal descriptions and easement exhibits.

Must have strong math skills, computer skills and the ability to work well with others in a team environment. In addition to a strong technical skill set, the position requires basic proficiency with AutoCAD.

Specific job tasks include:. Applicant should have advanced knowledge of modern survey practice and technology. General Requirements:. If you meet these qualifications and are ready for an exciting, challenging and rewarding career please apply at www.

Please note: tickets are non-refundable. Matt Brandt Multicare Associates Mr. Brandt is CEO of Multicare Associates in the Twin Cities, a primary care physician group that has been piloting a direct pay primary care model since In , he founded a health care cooperative, PrimaCare Direct, which includes over doctors and offers direct pay health care services to employers and patients in the Twin Cities.

We also compared cooperative made up of health care providers who data from different health plans to determine what work together to market medical services directly their per member, per month spend was on primary to patients and employers.

I prefer to think of care. Then we looked at our primary care spendPrimaCare Direct as a group of physician practices ing and researched what other direct primary care that understands how to practices were charging. The good The goal should really be side of the current system. The goal significantly exceeded the monthly fee. Cooperative pracoverall cost of care?

Currently, the big trend for employers is to care. Instead of direct pay medical home. The defining elements of managing their care with their primary care proDPC is to create improved access to primary care vider they wind up in the emergency room, which and to ensure that patients have an enduring and drives up the cost of care.

One ER visit can pay for trusting relationship with their primary care providers. Fee-for-service incentives are replaced with a eight primary care visits. PrimaCare Direct eliminates the barrier for patients to see their primary simple flat monthly fee.

It encourages good utilization teaching a patient to use their inhaler properly versus health outcomes, a better patient experience, and bad utilization a patient ending up in the ER with lower costs.

PrimaCare Direct has also started to an asthma attack. Independent physician groups include specialty services. Specialty practices can join the cooperative and provide procedures or care have typically been very good at developing outpatient capabilities, imaging centers, surgery centers, packages for one bundled fee instead of having diagnostic labs, etc. Often, specialty physician groups can deliver the same high-quality services in an outpatient setting for 20 percent to 50 percent less than at a hospital.

The monthly fee is capped at four family members, so additional family members are free. Early results have been promising. Multicare Associates has been using this model with its employees for some time and has kept its health plan costs under control for the past seven years.

Over that time, the average cost has declined slightly, which is incredible considering that the industry average has increased in cost somewhere between 8 percent to 10 percent a year depending on which source you quote. The current PrimaCare membership is showing a dramatic decrease in ER visits with the. So trying to find brokers to work with The two biggest and unexpected challenges have been, 1 the number of patients on gov- who understand the PrimaCare Direct model ernment programs or receiving benefits from and are not afraid to make changes has been difficult.

We are looking for a government agency. This just means that the PrimaCare coverage? PrimaCare Direct is currently worksurance brokers who are generally paid in ing to develop and sell its own high deductcommission from the insurance company rate being visits per 1, patients versus the norm of visits per 1, Groups running the DPC model of care around the country are seeing similar results.

If an employer is searching for a way to lower their health care costs without sacrificing access, coverage, or quality then PrimaCare Direct is a potential solution.

Ideally, I would love to see PrimaCare Direct grow to cover over 10, people here in the Twin Cities within the next year. At that scale it would be hard to refute our results and it would be easier to more aggressively market the concept.

This is a stretch goal, but I think it is very doable at our current pace as we have more than doctors currently on board who care for over , patients. If we can convert over 3 percent of those to the new model we can achieve this goal.

University of Minnesota – Continuing Professional Development Education is essential to achieving and sustaining quality healthcare. Through partnership with healthcare leaders, our educational activities help advance quality improvement and patient care initiatives.

Rinaldi shared his concerns and told the patient that he needed to get a medical clearance letter from his physician before he would perform the procedure. The patient visited his family physician and eventually received clearance after his doctor prescribed medications to treat his condition. Rinaldi later learned that the patient underwent further diagnostic testing, and his physician discovered an adrenal gland tumor that he surgically removed. When Dr. Rinaldi saw this patient a few months later, he discovered the patient had undergone an amazing trans-.

To his surprise, the patient had lost a dramatic amount of weight. He told Dr. While that is still largely true, a growing number. There is ample opportunity for dentistry and medicine to integrate the oral health dimension into a model of total patient-centered, overall health.

As a result, many physicians have little more than a basic understanding of many oral health issues. Physicians would benefit from training opportunities—most likely in the form of continuing education or specialized training sessions— provided by practicing dentists.

As a physician with hearing loss since childhood, I have used a number of audiology services over the years. None has been more competent, friendly and home-like atmosphere than the offices of Dr.

Paula Schwartz. Her office treats me the way I would hope my own office treats our patients. The recommendations and hearing devices have always been of excellent quality. James Rohde, Allina Health. Physicians could even perform some simple oral procedures. For example, it would be beneficial to their patients if pediatricians offered fluoride treatments, especially if their practice works with children who have limited access to a dentist. There is a better solution. Patients presenting with dental issues in an emergency room is another area where dentists and physicians could coordinate efforts.

One opportunity would be to divert or transfer the patient—barring the absence of other significant injuries—to a dental office to receive the appropriate care. If a patient needs to remain within the emergency room, the opportunity still exists for a dentist to provide clinical care. Chronic disease management As a physician, you see the prevalence of chronic medical conditions such as diabetes, heart disease, cerebrovascular disease, and rheumatoid arthritis, to name just a few.

Many of these patients with chronic conditions suffer from. A more aggressive collaboration between physicians and dentists to address this issue would create a number of benefits.

A collab-. It is difficult for physicians to set up dental consultations and any recommended treatment in a. A recent study by United Concordia Dental supports this theory.

United Concordia Dental found that people who were pregnant or had chronic conditions and received and maintained treatment for periodontal disease saw dramatic drops in hospitalization and physician visits, saving thousands of dollars a year in medical costs. A program designed to address oral health and chronic disease management should be part of most large health care systems. The objective of this program would be to identify patients with chronic health issues and assess their oral health status.

This program could then work with their health insurance or medical assistance plans to ensure that their oral health needs are appropriately addressed. There are, however, occa-. This is clearly an opportunity for health care organizations that do not have dentists on their staff to establish relationships with dentists in their communities.

Once again, with the right working relationship, it could truly enhance the care provided to the patient. Dental office health screenings Many dental teams already regularly perform basic medical screenings, including those for hypertension, oral cancer, and TMJ facial pain issues. For some patients, their semiannual dental visit might be the only time they see a health care professional during any given year and health-related issues can certainly surface in that timeframe, especially as Forging new alliances to page V Center for Urinary and Pelvic Health, including urodynamics.

V Certified nurse midwifery. V Gynecologic care, including well-woman screenings and in-office procedures. V Gynecologic surgeries, including minimally invasive surgeries and robotics for conditions such as endometriosis and pelvic organ prolapse. V Infertility evaluation and treatment. Patient-friendly early morning, evening, and Saturday hours. E-health is also essential in supporting the exchange of information necessary for care coordination. This plan includes establishing uniform health data standards for securely sharing data across systems.

The e-Health Initiative continues to monitor state and national activities and guides Minnesota providers on how they can leverage EHRs to achieve the promised benefits of the Triple Aim: improved patient experience of care, reduced health care costs, and improved public health. Effective use of EHRs means that the EHR includes tools and processes such as e-prescribing, clinical decision support tools see Table 2 on page 19 , and that staff are adequately trained to use the technology.

EHRs are most effective when using nationally recognized standards that enable interoperability with other EHR systems. Interoperability and health information exchange The goal of health information exchange HIE is to make health information available, when and where it is needed, and to improve the quality and safety of health and health care. Nine in 10 clinics 93 hospitals or clinics, although percent and all Minnesota their need to exchange inforhospitals have adopted an EHR.

The most common important? HIE is also happening comes from using it effectively between organizations that to support efficient workflows. Table 1. T rends in the adoption of electronic health record systems among Minnesota clinics, — Instead, MDH provides support to providers to help them achieve the goal of statewide interoperability.

Table 3. Restoring function to patients with chronic neck and back pain. Interoperability is the ability of two or more systems or components to exchange information and to use the information. In the context of HIE, interoperability is achieved by using standardized terminology and data structure in the various types of clinical data transactions e.

While most of these standards have been developed, adoption and use of these standards is still limited. It was officially incorporated in December as a nonprofit corporation in Minnesota, however, the idea of independent facilities working together was born years earlier. The cost of health care Multiple changes in the health care industry are driving changes in reimbursement as well as patient utilization. Since , the inpatient rate has dropped throughout the U.

The trend is expected to continue throughout the next decade, even in states with loosely managed utilization trends. Minnesota, considered to be a state with conservative admitting patterns and an overall healthier population,. Another key issue impacting revenue is the shift by payers, starting with Medicare, from quality incentives to penalties.

Hospital-acquired infections and readmissions are reducing payment rates for providers. Patients can and should expect high-quality care from providers. The burden for providers is ensuring that there is staff available to interpret the measures, review and report on results, and identify and implement opportunities for improvement.

The challenge is in the delay between the. Out-of-pocket costs for patients have risen dramatically over the past decade as employers have shifted costs to employees in an effort to slow employee benefit costs.

Deductible costs for individuals not covered by employer-sponsored health insurance are even higher. Copays and co-insurance add additional patient costs. Many patients are choosing to delay medical care as a result of their out-of-pocket costs. Regional demographics In addition to reimbursement changes, health systems in northeastern Minnesota are challenged by the demographics in the region. Medicare is the largest payer for all Wilderness Health members and many have a significant number of Medicaid patients also, meaning that contracted rates are much lower than other payer types.

Forming the collaborative Given these financial challenges, several hospitals in northeastern Minnesota began discussions several years ago to identify how they could work together in a more cost-effective, efficient manner that would maintain their independence yet still provide their patients with quality health care. The governance structure among the participants varied. All are nonprofits, but some are hospital districts with public boards, some owned nursing homes, and most are critical access hospitals.

Many do not employ physicians in their facilities and instead have Federally Qualified Health Centers FQHCs or independent physicians in their communities. The groups that initially joined the collaborative would be considered charter members, with approval rights reserved on any new groups that wanted to join at a later date. Discussions continue with additional hospitals, clinics, provider groups, and stakeholders such as local counties about how we can work together.

All members have agreed to resource commitments, including financial and time, in order to be part of the collaborative. Each charter member has a seat on the board of directors, regardless of size. Members delegate a senior executive from their organization typically their CEO to serve on the board. Membership agreements and budget allocations were approved for and to launch the organization. Because of the large geographical area and traveling distance.

Charter members The charter members of Wilderness Health are located in some of the most rural areas of Minnesota and patients often must travel many miles for access to services.

Seven of the nine charter members are critical access hospitals of 25 beds or less. Six facilities also have long-term care facilities on their campus, many of which are owned by the hospitals themselves. Cook Hospital Cook, Minn. There are some initiatives that will be addressed during the first years of the collaborative. Emerging evidence in the field of minimally invasive gynecology is helping those who treat endometriosis to better understand the treatment modalities that are effective in managing this enigmatic disease.

Endometriosis affects 6 percent to 10 percent of reproductive aged women and is one of the most common sources of chronic pelvic pain. Endometriosis refers to the presence of viable, estrogen-sensitive endometrial glands and stroma with an associated inflammatory response outside of the uterus.

Several conditions show greater concordance with endometriosis: 21 percent to 47 percent of women presenting with subfertility; 71 percent to 87 percent of those with chronic pelvic pain; and 69 percent of adoles-. Endometriosis also has a strong familial component and first-degree relatives of individuals diagnosed with endometriosis are seven to 10 times more likely to have the disease themselves.

Economic burden Endometriosis is a public health issue that bears an important economic burden. It not only causes pain and infertility, but also has consequences related to medication, health care consumption, work absenteeism, impaired quality of life, and psychosocial factors. Most experts agree that the disease is multifactorial in etiology but distinct pathophysiology is not well understood.

Factors such as retrograde menstruation, metaplastic changes of pleuripotent mesothelial cells, and implantation of cells through hematogenous or lymphatic embolization may play a role in the development of endometriosis. While most women appear to have some degree of retrograde menstruation, not all women develop endometriosis.

Those who have endometriosis may have an inherent immune dysfunction that impairs normal clearance yet promotes disease progression. Treatment Laparoscopy is considered the gold standard for the diagnosis of endometriosis with visual identification of classic endometriosis lesions.

Histologic confirmation is helpful because visual identification is associated with a high false positive rate. Many patients may be erroneously diagnosed with or without endometriosis due to the lack of a biopsy of the peritoneum at the time of surgery to provide histologic proof of the existence of endometrial glands and stroma in the sample.

Medical management of endometriosis involves hormonal suppression of endometriosis with oral contraceptives and GnRH agonist medications.

The aim of medical management. These therapies can be effective but symptoms usually reoccur shortly after the medication is discontinued. Surgical management of endometriosis has largely focused on the destruction or removal of all visible endometriosis lesions.

These lesions can take many forms, with the classic presentation being a powder-burn appearance on the surface of the abdominal peritoneum. Endometriosis lesions can also be red, blue, white, or have a more flattened, scarred appearance. Many providers believe that simple ablation of the superficial endometriosis implants is an adequate surgical treatment for the disease.

This is usually accomplished with the use of bipolar or monopolar electrocautery. The lesions are usually burned superficially without exploration and removal of the underlying retroperitoneal tissue. Evidence suggests that this type of therapy is inadequate and that true excisional surgery is much more effective in alleviating pain due to endometriosis and preventing recurrence of the disease.

Most patients have their pain return in less than a year after having ablative, non-excisional surgery. More important, these methods do not allow confirmation of visual diagnosis by a pathologist. Safety of their application to endometriosis treatment has been questioned.

Emerging evidence A recent randomized, controlled trial by Healy, et al. Published in the December issue of the Journal of Minimally Invasive Gynecology JMIG , this study compares the efficacy of these two surgical modalities for a variety of outcomes.

Their previously published, one year follow-up. However, when the same patients were interviewed five years after their surgery some differences emerged. Of those that returned the pain assessment survey after five years, 45 patients had undergone excisional surgery and 42 patients had ablative surgery for endometriosis.

Both modalities in surgical management proved effective in reduction of overall pain including menstrual-related pain and pain with voiding or defecation. The statistically significant difference was revealed in that patients who had undergone excisional surgery had less pain related to dyspareunia and less need for medical therapy after surgery.

It is possible that if the response rate of the survey had been higher, more differences may have been found. This study does help us to understand that deep infiltrating disease, which is often the cause of dyspareunia, is better treated with excisional surgery.

Advanced surgery When considering where to refer a patient for management of endometriosis or chronic pelvic pain it is important to understand what patients can expect from their surgeons.

Surgeons performing endometriosis resection surgery must be comfortable with complicated pelvic adhesions and dissection of retroperitoneal anatomy. They must be able to navigate bladder and bowel involvement of endometriosis and resect the diseased tissue from these structures.

Endometriosis surgeons should be able to repair any bladder and bowel defects caused during resection surgery and must be able to navigate the challenges of a frozen pelvis.

Gynecologists performing endometriosis surgery must have a close working relationship with like-minded colleagues in the fields of urology, colorectal,. Surgical resection can be planned and completed for even the most challenging of patients. Endometriosis was detected in Additional research reveals that endometriosis is being detected and treated more effectively than ever with advanced laparoscopic surgical technology and the da Vinci surgical robot. Robotic surgery allows the surgeon to work comfortably, reducing fatigue from standing and bending in a long surgical case.

Advanced optics allow visualization in high definition with 10x magnification and 3D and many surgeons believe they can see more disease than they were able to with a traditional laparoscope. Delumba and colleagues reported a Additionally, advanced robotic technology such as Firefly uses integrated fluorescence imaging capability, which provides real-time, image-guided identification of key anatomical landmarks using near-infrared technology.

This technology, which has been used since the s for angiography and hemodynamic monitoring, is now finding an application in minimally invasive gynecology. Firefly takes advantage of the highly vascular nature of endometriosis and helps surgeons identify areas of neovascularization, which is common in this disease. Leaders in endometriosis resection feel that this technology may ultimately help surgeons see more endometriosis and obtain better surgical margins for resection.

While this technology remains. Conclusion Endometriosis is a common disease in women of childbearing age. This disease can be difficult and challenging to manage for health care pro-. With recent advances in minimally invasive surgery and surgical technology, the management of endometriosis is becoming better understood. As minimally invasive surgeons continue to move the management of endometriosis forward, we are hopeful to see a reduction in the long-term consequences of this disease.

Referring physicians should seek out those providers who are comfortable with management of all presentations of endometriosis. A collaborative effort is needed to continue to move this effort forward. He specializes in minimally invasive surgery with a focus on managing uterine fibroids, endometriosis, and pelvic organ prolapse. Quality Transcription located in Minnesota maintains a professional office environment, thus the confidentiality of your work is strictly maintained.

We provide medical transcription services on a contract or overload basis. Our equipment is state of the art with 24 hour dictation lines and nationwide accessibility. We are experts in our field. We deliver on time. We have experienced staff. We monitor the quality of our work.

We provide services tailored to your needs and will do whatever it takes to get the job done. Quality Transcription, Inc. The National Institutes of Health NIH and the Food and Drug Administration FDA are just two organizations that will work to develop the resources necessary to attain these objectives: 1 more and better treatments for cancer, 2 creation of a voluntary national research cohort, 3 commitment to protecting privacy, 4 regulatory modernization, and 5 public-private partnerships.

At the center of precision medicine is pharmacogenetics. What is pharmacogenetics? Different patients can show dramatically different responses to the same medication. Physicians and patients are often left waiting to see if a new medication works and if it is safe. For example, patients lacking glucosephosphate dehydrogenase G6PD activity are more prone to increased side effects from a number of medications.

What other genetic. Watch your patients smile! Customize your interior design with familiar but unique art that will comfort and delight all ages. Seuss dealers. We have many pieces in stock and are pleased to offer them to the health care industry. Louis Park, MN The ultimate goal is to use genetic information to tailor drug therapy that is safe and effective. It is also being used to discover new targets for drug therapy. Pharmacogenetics generally refers to a relatively small number of genetic markers, while pharmacogenomics usually refers to a set of markers spanning the entire genome.

Individual enzyme testing The FDA maintains a list of approved drugs with pharmacogenomic information on their labeling. Labeling does not translate directly to genetic testing, however. As of Aug. Some of these drugs include the commonly prescribed celecoxib, codeine, glipizide, metoprolol, and warfarin. Classical pharmacokinetics can describe drug absorption or uptake, metabolic activation or deactivation, and elimination. These pharmacokinetic properties are determined by enzymatic activity that itself is determined by genetic sequence.

Variation in sequences in genes active in any pharmacokinetic process can alter the activity and side effects of a drug. Predicting how genetic variation will affect pharmacokinetics in any one individual is the promise of pharmacogenomics. Most medications are subjected to a variety of metabolic enzymes that alter the drug.

If a drug is metabolized quickly, it may be eliminated before reaching effective levels. One large family of drug metabolizing enzymes is known as cytochrome P Variations in toxicity and activity of a large number of medications are influenced by variations in genes coding for P enzymes.

Tamoxifen is an example of a commonly used medication that is metabolized by a cytochrome P enzyme. One of the P enzymes is responsible for converting tamoxifen into a more active form. Genetic polymorphisms variations that are more common than 5 percent in the general population within this particular P gene can be responsible for less tamoxifen activation.

Whether people with the less active P enzyme have different breast cancer outcomes is currently under investigation. Warfarin is another drug that is metabolized by P enzymes. Clinical genetic tests are available to determine if an individual is likely to inactivate warfarin quickly or slowly, and may aid in initial dosing decisions. Since clotting times are measured so frequently with international normalized ratios INRs , the genetic test is rarely used clinically and there is no universal agreement as to its cost effectiveness.

Genetic variations in genes leading to altered drug metabolism are fairly rare in the general population. Therefore, testing individual enzyme activities would lead to a large number of negative tests. The inefficiency of this approach has limited routine enzymatic testing. Genetic testing An alternative to individual enzyme tests is genetic testing. The gene coding for important enzymes in drug metabolism can be sequenced to determine if a person is likely to have.

The appeal of this approach is the increasing efficiency in sequencing genes. The human genome consists of 3,,, base pairs. This large investment initiated a wave of innovation leading to a dramatic drop in the price of DNA sequencing.

This technologic revolution makes testing the genes of interest more cost efficient than testing enzyme activity. Some companies have offered DNA sequencing services directly to the public. The genes sequenced include those responsible for some genetic disorders as well as genes involved in drug metabolism.

One company that offers these sequencing services, 23andMe, was required to stop in November by the FDA. The issue that forced the suspension is whether DNA sequencing is a medical test subject to FDA control or simply a source of personal information not subject to FDA regulation.

The case with 23andMe is still ongoing and shows how rapidly this technology is changing. Using a screen reader or another type of assistive technology for your job search? Enter our accessible applicants portal. Accessible applicant portal. Search for Jobs Join a group of exceptional people who share a common passion for public service.

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