At Montana State Fund, serving the businesses of Montana is what we do and it's who we are. It's what makes us different. We partner with employers and their employees to care for those injured on the job and we champion a culture of workplace safety for our fellow Montanans.
On the Medical Services Team, we're providing a high level of medical expertise across the organization to support both internal and external customers. This is an excellent opportunity for a medical professional with clinical experience to provide valuable input and guidance while working in a collaborative environment with a team of passionate, motivated professionals. If you want to make a difference working on rewarding and dynamic challenges read on to learn more about this exciting opportunity to join the Montana State Fund team!
About the Role
With a high level of medical expertise and under minimal supervision serves as medical case management expert, auditor and resource to Montana State Fund regarding medical claim management and Claims Best Practices and provides recommendations for longer term claims that may have complex medical issues to assist in determining appropriate medical reserves. At times of decreased staffing, will provide early intervention medical case management to examiners and injured workers.
What You'll Do
Provide medical case management services on a limited basis to a limited number of claims examiners to support medical case management team with overflow.
Communicates with injured workers, medical providers and others.
Assists Claims Examiners with injured worker diagnoses, treatment plans or medical services.
Provide education, consultation, and assist with RTW efforts.
Reviews Large Loss claims and completes rated ages from the Strategic Team, collaborates with the Claims Examiner after the review, and attends the scheduled Large Loss meeting.
Attend, large loss meetings to support recommendations in determining the final plan of action for the claim being reviewed and as needed will attend litigation, mediation, DOM care or large purchase meetings.
Research, analyze and provide treatment plans with evidence-based best practices, and Montana Utilization and Treatment Guidelines in collaboration with other medical professionals to ensure the best possible medical outcome for the injured employee.
Analyze medical claims management issues with other claims professionals through communication, coordination and facilitation of information to assist with return to work efforts.
The MMS may be required to make presentations to claims examiners, other nurses or at All Employee meetings.
Assist MCM and CE with file reviews during times of MCM shortage or high volume of EI claims, for early intervention of claims focusing on medical provider records. Interviews the injured employee and collaborates with other team members to facilitate and identify appropriate medical care.
Assists with and, conducts quality assurance reviews for medical case managers and strategic claim management on a quarterly basisand reports results to Nurse Manager.
Analyzes quality assurance reviews for medical case and strategic claim management on a quarterly basis and reports results to Nurse Manager; identifies trends and proposes actions steps for improvements.
Assists with orientation of new hires to Medical Management processes and MT Utilization and Treatment guidelines and ongoing training as needed.
Provides reports and trends as directed.
What You'll Need (Minimum Qualifications)
Case management experience in workers' compensation.
Any of the following certifications:
Certified Case Manager, Certified Rehabilitation Registered Nurse, Certified Occupational Health Nurse, Certification in Case Management, Community Health, Certified Managed Care Nurse, Home Health or Medical-Surgical Nursing.
Montana State Fund