• Address: Helena, MT 59604 (map)
• Date Posted: 09/22/09
• Job Type: Full-time

Nurse Case Manager
Duties: Provide medical case management for medically complex claims, especially catastrophic claims. Serve as medical resource for claims staff and provide guidance and information on specific claims. Some travel required.
Qualifications: Self-motivated, energetic, and effective team member wanting to be an integral part of the mission. Must be customer service oriented, ability to take the initiative, accountability, and job knowledge.
Education: Master’s degree in related field preferred, one of the following certifications are required:
· CCM – Certified Case Manager
· CRRN – Certified Rehabilitation Registered Nurse
· COHN – Certified Occupational Health Nurse
· RN,C – Certification in Case Management, Community Health, Home Health, or Medical-Surgical Nursing.
· CMCN – Certified Managed Care Nurse

Medical Management Specialist
Location: Helena, MT
Duties: With a high level of medical expertise and under minimal supervision serve as medical case management expert, auditor, mentor and resource to Operations and Operations Support team members in regards to medical claim management and Claims Best Practices. With a primary emphasis on improving strategic medical case management processes, identify processes, results and trends. Resolve issues across teams. Identify and address technical development needs for existing staff. Provide staff orientation and development, conduct quality reviews for medical case and strategic claim management on a quarterly basis, and develop or coordinate specialized training as indicated. Analyze medical claims management issues with other claims professionals through communication, coordination and facilitation of information. Lead and facilitate monthly case manager and strategic nurse meetings. Provide orientation for new hires.
Qualifications: Self-motivated, energetic, and effective team member wanting to be an integral part of the mission.
Core Competency: Customer Service, Initiative & Accountability, Job Knowledge, Communication, and Decision Making
Education and Experience: Requires a current RN, APRN, or PA license and 4 years clinical experience, with 2 years workers’ compensation related experience and 2 years of experience in the design, development, implementation, evaluation and/or supervision of a medical management program. Master’s degree in a related field is preferred.
Strategic Nurse Consultant (2 positions available)
Location: Helena, MT
Duties: With a high level of medical expertise and under minimal supervision provide strategic case management for long term TTD, PTD and PPD claims with complex medical issues to establish medical stability or claims closure. Conduct intensive files reviews, develop and implement long range action plan strategies that lead to claims closure or medical stability. May serve as the medical resource for injured employees relating to diagnosis, treatment plan, or medical services. Research and analyze provider treatment plans with evidence-based best practices and negotiate an acceptable course of action with multiple providers. Analyze medical claims management issues with other claims professionals through communication, coordination and facilitation of information, and negotiate appropriate treatment plans with medical providers. Evaluate on-going services provided to ensure provider compliance with negotiated treatment plan and medical care is effective. Occasional travel with some overnight stays required.
Core Competency: Customer Service, Initiative & Accountability, Job Knowledge, Communication, and Decision Making
Education and Experience: Requires current RN, APRN, or PA licensure and 4 years clinical experience and 1 year medical case management experience. Workers’ Compensation experience preferred. Master’s degree in a related field is required. The following is Preferred:
· Certified Case Manager (CCM)
· Certified Rehabilitation Registered Nurse (CRRN)
· Certified Occupational Health Nurse (COHN)
· Certification in Case Management, Community Health, Home Health, or Medical-Surgical Nursing (RN,C)
· Certified Managed Care Nurse (CMCN)