3,028 jobs in Orchard Homes, MT

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Provider Contract Analyst/Contract Developer

Highmark Health
Orchard Homes, MT
**JOB SUMMARY**

This job manages contracts including negotiations, contract development, contract renewal, and financial reimbursement. Acts as the intermediary between the organization and outside entity/state regulators. Responds to contractual and payment issues both internally and externally. Ensures compliance with contractual terms.

**ESSENTIAL RESPONSIBILITIES**

+ Monitor activities by tracking the specific terms of each contract and maintaining some mechanism for monitoring and documenting compliance with those terms. Perform special studies/audits, coordinating office site visits and medical records reviews, ensuring resolution of member/provider complaints in timely manner.

+ Prepare periodic reports that summarize compliance with key responsibilities outlined in the agreement for both internal and external audiences. Conduct, collect and analyze data from claim and/or medical record reviews to continually improve the care and service to members and coordinate with the financial recovery areas to retract erroneous or inappropriate payments.

+ Manage contracts including negotiations, contract development, contract renewal, and financial reimbursement.

+ Act as the intermediary between the organization and outside entity to ensure all responsibilities as outlined in the contract are fulfilled. Serve as an advocate for managing expectations to achieve positive outcomes. Participate in educational and training sessions for provider billing staff to ensure understanding of and compliance with proper guidelines.

+ Provide control and processing support for final provider settlements and initiating, documenting, processing, and establishing collection protocols for provider settlements.

+ Work with sales and customer service to respond to questions/inquiries from customers/members related to appropriateness of services billed by providers. Consult with Medical Director
New
2d ago

CDL-A Dedicated Company Truck Drivers | $80k Year Average!

Kenan Specialty Products
Orchard Homes, MT
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7d ago
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Senior Simulations Software Engineer

Cubic Corporation
Orchard Homes, MT
60d+ ago

Supply Chain Technician I *$1000 Sign On Bonus*

Providence Health & Services
Missoula, MT
New
2d ago

HealthCare Traveler Cardiac Cath Lab RN

Healthcare Traveler Jobs
Missoula, MT
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2d ago
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Accounts Payable Clerk

Cennox
Missoula, MT
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2d ago

Certified Medication Aide 2

Hillside Health Care Center
Missoula, MT
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2d ago
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Director of Nursing - Sign on Bonus Available!

Riverside Health & Rehabilitation
Missoula, MT
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2d ago
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Cashier (Good4u Customer Care)

Natural Grocers
Missoula, MT
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2d ago
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Seasonal Brand Associate - Southgate Mall

The Gap, Inc.
Missoula, MT
New
2d ago

CNA Certified Nursing Assistant - Training provided!

The Village Health & Rehabilitation
Missoula, MT
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2d ago
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Caregiver-Resident Assistant - PRN

The Village Senior Residence
Missoula, MT
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2d ago
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Manager IT

Highmark Health
Orchard Homes, MT
**JOB SUMMARY**

This job provides application software development management for IT projects. Creates plans and manages activities, within an assigned unit/area. Assesses viability of current direction/projects/operations and recommends strategies and tactics to satisfy current and future business needs. Foresees organizational impacts and understands the procedures associated with introducing new technologies. Leads team in the areas of scheduling, direction, future planning and standard practices. Monitors and controls quality while actively seeking opportunities for improvement. Establishes and meets scheduled milestones for deliverables.

**ESSENTIAL RESPONSIBILITIES**

1. Communicate effectively with all levels of the organization by:

+ Managing customer and expectations; facilitating, planning and meetings; translating customer expectations for staff and peers; representing Highmark with outside entities.

+ Preparing written procedures, policies, reports and correspondence; collaborating and negotiating with departments corporate wide.

+ Collaborating with company customers, staff, IT colleagues, and other stakeholders in identifying customer requirements, assessing impacts to other areas, considering available options, comparing costs and benefits, and recommending solutions.

2 Management Consulting

+ Identify issues and recommend solutions.

+ Create presentation and present concept to clients, tailoring presentation to audiences of varies levels, subject knowledge and size.

+ Implement recommendations/solutions and ensure client receives the necessary assistance to carry out solutions.

+ Liaising with clients to keep them informed of progress and to make relevant decisions.

+ Advise clients on options, risks, cost vs benefit, impact on other business processes and system priorities.

3. Ensure continuous im
8d ago

Manager Internal Communications

Highmark Health
Orchard Homes, MT
**JOB SUMMARY**

This job manages the development, design and delivery of all employee communications and communications programs that support the brand, vision, mission, and strategic direction of the business for Helion. Consults with and provides leadership, guidance and oversight for the work done by staff members, vendors and consultants for Senior Management teams throughout the business and its subsidiaries to proactively identify and develop key messages and determine the media to be used to deliver them. Accountable for all executive communications. Develops and monitors relevant social media communications for employees (LinkedIn, wikis, pods, etc.), relative to the corporation's social media policy.

**ESSENTIAL RESPONSIBILITIES**

+ Perform management responsibilities to include but are not limited to involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary.

+ Consult with Senior Leaders to proactively identify strategy and develop and execute key messages, including determining the appropriate media, the packaging, branding, communication plans, and delivery of critical organizational messages to employees.

+ Oversee the development, writing, editing, approval, and targeted delivery of all content published in all Helion print and electronic employee communications. Media channels include, but are not limited to, digital screens, employee and external newsletters, company intranets, website design, bulletin boards and console ads across the business.

+ May be responsible for executive communications such as 1) Launch and direct communications plan for new market introduction, 2) Development of quarterly Management Meeting content and messaging, 3) Leading, De
9d ago

Manager Enhanced Community Care Management

Highmark Health
Orchard Homes, MT
**JOB SUMMARY**

This job is accountable for leading a trans-disciplinary care team in the delivery of palliative and care management services to a seriously ill population. The incumbent manages, supervises and coordinates the daily operations of a department providing clinical and administrative leadership and expertise. The incumbent is accountable for staffing and scheduling to ensure care management services and clinical care delivery is effective and completed within defined time frames and according to established processes. The incumbent ensures that team members are clinically competent and adequately trained n order to achieve member engagement targets as well as defined clinical and financial outcomes. Establishes and monitors individual and team performance goals providing feedback and taking action to ensure that goals are achieved. Contributes to the strategic planning process and attainment of goals of the department, the organization and the provider partners.

**ESSENTIAL RESPONSIBILITIES**

+ Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.

**LEADERSHIP:**

+ Responsible for implementation of mission, vision, philosophy, core values, evidence based practice (EBP), and standards of the organization, within their defined areas of responsibility.

+ Demonstrates and role models professional behavior with all staff interactions.

+ Serves as change agent and role model for change to assist staff in accepting and embracing the necessary change.

+ Collaborates with physician advisors and partners to share perform
New
3d ago

Associate Technical Support Analyst - Ticketing - 3rd shift

Highmark Health
Orchard Homes, MT
**This is a 3rd shift position.**

**JOB SUMMARY**

This job assists the front-line ticket triage and resolution. The incumbent expeditiously assists in the initial problem ticket review, assessment of information/details for updates, corrections and information cleansing, as needed, and transfer the ticket to the appropriate area for resolution. Responsibilities may include assisting to handle the issue hotline and Quotation management process with clients with oversight and support from Intermediate and Senior team members.

**ESSENTIAL RESPONSIBILITIES**

+ Expeditiously assist to monitor, triage, and forward problem tickets to appropriate area for resolution.Tasks include removal of all Protected Health Information (PHI) from the problem ticket, ensuring all necessary information is included in the ticket, attachments are included and viewable, and if appropriate, forwarded on to the proper group for resolution, with oversight and guidance from Intermediate and Senior Team members

+ Support the maintenance of the Issue Hotline for internal ticketing process by reviewing telephonic hotline inquiries, which may include educating the caller on how to submit tickets online.

+ Provide assistance in the process oversight for Quotation Management process.Ensure toll gates are in place so client agrees with project quotes, timing, process, cost, etc.

+ May assist to update training documentation for process improvements and process changes for group.

+ Other duties as assigned.

**EDUCATION**

**Required**

+ High School Diploma/GED

**Substitutions**

+ None

**Preferred**

+ Bachelor's Degree in Information Technology or Business Administration/Management

**EXPERIENCE**

**Required**

+ 0 - 1 year in the Health Insurance Industry

**Preferred**

+
10d ago

Wellness Coach

Highmark Health
Orchard Homes, MT
**GENERAL OVERVIEW:**

The focus of this position is towards member lifestyle improvement. The job must have the ability to review data and assist the member in understanding their lifestyle risks, and work collaboratively with the member or team to arrive at a plan to promote positive behavior change.

**ESSENTIAL RESPONSIBILITIES:**

+ Conducts member-focused interviews and coaching with moderate risk individuals through pre-defined lifestyle interventions as identified primarily by health risk assessment (HRA) and biometric screening data.

+ Utilizes motivational interviewing skills to reduce ambivalence and clarify goals and support coaching timeframes and support processes driven by need, interest and readiness of the member.

+ Provide member coaching in a variety of settings (i.e. telephonic, onsite, virtual).

+ Other duties as assigned or requested.

**QUALIFICATIONS:**

Minimum

+ Bachelor's degree in a clinical field of study: Nutrition, Health Education, Health Promotion, Exercise Science or Public Health

+ 1 - 3 years of experience or background working in such health care/clinical roles as a registered dietician, exercise physiologist, or wellness and lifestyle coach in an environment that focuses on a wellness model of program delivery

Substitutions

+ Prior experience with research studies, clinical trials and more formal health/wellness education

**Knowledge, Skills and Abilities**

+ Familiarity with Highmark's preventative health services programs & services

+ Skilled in basic computer skills and software applications

+ Comprehensive knowledge and understanding of current health education practices

+ Knowledge of Prochaska's Transtheoretical Stage of Change model

+ Experience working in a team environment that supports the management of health s
10d ago

Pharmacist - Utilization Management (UM)

Highmark Health
Orchard Homes, MT
**JOB SUMMARY**

This job reviews requests for medication coverage determination for prior authorization review and appeals, specifically medical injectable drugs. Through the Utilization Review system, the incumbent evaluates clinical information provided by the physician against medical policy criteria. The incumbent then uses his/her clinical knowledge compared to the policy and physician request to make a determination. At times, the incumbent may conduct additional research beyond medical policy review to make coverage determinations.

**ESSENTIAL RESPONSIBILITIES**

+ Make coverage determinations by evaluating physician requests for prior authorization or appeals against medical policy through the Utilization Review system. Update the system records appropriately to ensure claims are properly routed and paid.

+ Conduct research beyond medical policy review to make decisions on medication coverage requests.

+ Other duties as assigned.

**EDUCATION**

**Required**

+ Bachelor's degree in Pharmacy

**Substitutions**

+ None

**Preferred**

+ Doctorate degree in Pharmacy

**EXPERIENCE**

**Required**

+ 1 - 3 years in Pharmacy

**Preferred**

+ None

**LICENSES OR CERTIFICATIONS**

**Required**

+ Registered Pharmacist

Preferred

+ None

**SKILLS**

+ Oral & Written Communication Skills

+ General Computer Skills

+ Problem Solving & Decision Making

+ Compliance

+ Prioritizing

**Language Requirement (other than English)**

None

**Travel Required**

None

**PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS**

**Position Type**

Remote

Teaches / trains others regularly
8d ago

Director Enterprise Behavioral Health Clinical Quality and Engagement

Highmark Health
Orchard Homes, MT
**JOB SUMMARY**

This job is responsible to develop and implement Enterprise Behavioral Health policies and programs designed to advance high quality, evidence-based behavioral health treatment to include: lead and coordinate clinical design, development, and evaluation of provider competency-based training programs in evidence-based psychotherapies as part of the establishment of a Center of Excellence in Evidence-Based Psychological Treatments; provide clinical input into design of innovative payment models and other incentives; develop and implement programs to promote patient, member, and provider/employee engagement; develop and oversee clinical and non-clinical programs for promoting lower-intensity interventions and upstream approaches. Responsible for alignment and integration of clinical, operational and technological functions into the overall enterprise mission.

**ESSENTIAL RESPONSIBILITIES**

+ Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.

+ Collaborate across the enterprise to identify programs that align with the mission to improve care and improve patient experience/outcomes while reducing the overall cost of care. Direct development and implementation of programs designed to advance high quality, evidence-based behavioral health treatment; lead and coordinate clinical design, development, and evaluation of provider competency-based training programs in evidence-based psychotherapies; provide clinical expertise to inform identification and design of innovative payment models (e.g., value-based reimbursement, pay-for-performance) and other incentives
14d ago

Provider Info Mgmt Rep

Highmark Health
Orchard Homes, MT
**JOB SUMMARY**

This job is responsible for provider file maintenance. The incumbent ensures compliance with National Committee on Quality Assurance (NCQA), CMS, DOH regulations, BCBS, internal and private business audits. The incumbent is responsible for contract administration - inclusive of, but not limited to, contract generation, reviewing signed contracts, updating provider file and executing contract. The incumbent encompasses Provider Customer Service on a rotated schedule. This provider line is specific to the file maintenance and credentialing processes.

**ESSENTIAL RESPONSIBILITIES**

+ Communicate effectively and professionally. This position will display communications with varied sources which are not limited to, State licensing agencies, Provider offices, billing agents, provider representatives, management and internal staff.

+ Responsible to review the contract to ensure there are no changes, secure and execute standard provider contracts, materials, and information as required for the development of provider networks. Ensure compliance with terms of the provider contracts. Ensure compliance with the file maintenance and credentialing guidelines.

+ Ensure compliance with the following agencies, Federal Government, NCQA and CMS standards are met, American Healthcare Commissions URAC standards within the scope of WV contracts. Department of Labor (DOL), Department of Health (DOH) and/or the Insurance Department. Other agencies include, HIPAA, HEDIS and Highmark Health Services and all its affiliates' operational and Corporate policies.

+ Provide quality customer service to ensure all telephone or written inquiries received are handled promptly, accurately and consistent with department standards, documenting information accurately using internal inquiry tracking systems or credentialing database.

+ Contact external sources to collect or clarify information or documentat
11d ago

Manager IT

Highmark Health
Orchard Homes, MT
**JOB SUMMARY**

This job provides application software development management for IT projects. Creates plans and manages activities, within an assigned unit/area. Assesses viability of current direction/projects/operations and recommends strategies and tactics to satisfy current and future business needs. Foresees organizational impacts and understands the procedures associated with introducing new technologies. Leads team in the areas of scheduling, direction, future planning and standard practices. Monitors and controls quality while actively seeking opportunities for improvement. Establishes and meets scheduled milestones for deliverables.

**ESSENTIAL RESPONSIBILITIES**

1. Communicate effectively with all levels of the organization by:

+ Managing customer and expectations; facilitating, planning and meetings; translating customer expectations for staff and peers; representing Highmark with outside entities.

+ Preparing written procedures, policies, reports and correspondence; collaborating and negotiating with departments corporate wide.

+ Collaborating with company customers, staff, IT colleagues, and other stakeholders in identifying customer requirements, assessing impacts to other areas, considering available options, comparing costs and benefits, and recommending solutions.

2 Management Consulting

+ Identify issues and recommend solutions.

+ Create presentation and present concept to clients, tailoring presentation to audiences of varies levels, subject knowledge and size.

+ Implement recommendations/solutions and ensure client receives the necessary assistance to carry out solutions.

+ Liaising with clients to keep them informed of progress and to make relevant decisions.

+ Advise clients on options, risks, cost vs benefit, impact on other business processes and system priorities.

3. Ensure continuous im
8d ago

Project Manager

Highmark Health
Orchard Homes, MT
New
7d ago

CDL-A Dedicated Company Truck Drivers | Great Pay & Incentives

Kenan Specialty Chemical
Orchard Homes, MT
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New
6d ago
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Manager Product & Technology Solutions

Highmark Health
Orchard Homes, MT
28d ago

Director, Digital Cloud Software Engineering

Highmark Health
Orchard Homes, MT
15d ago

Senior Clinical & Population Health Analyst

Highmark Health
Orchard Homes, MT
22d ago

Manager Financial Systems - Oracle ERP Cloud- Projects (PPM/OTL)

Highmark Health
Orchard Homes, MT
60d+ ago

Architect - Security Architecture

Highmark Health
Orchard Homes, MT
60d+ ago

RN Medical ICU - Travel - Covid Response (MICU)

Healthcare Traveler Jobs
Missoula, MT
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2d ago
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HealthCare Travelers PCU RN Progressive Care Unit Travel

Healthcare Traveler Jobs
Missoula, MT
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2d ago
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Tele Registered Nurse (RN) - Telemetry - Travel Contracts

Healthcare Traveler Jobs
Missoula, MT
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2d ago
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Registered Nurse (RN) Med Surg - Urgent Needs CRISIS Travel Contracts

Healthcare Traveler Jobs
Missoula, MT
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2d ago
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Crisis Rate** URGENT**RN Emergency Department

Healthcare Traveler Jobs
Missoula, MT
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2d ago
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RN Registered Nurse Cardiovascular ICU / CVICU - Travel Contract

Healthcare Traveler Jobs
Missoula, MT
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2d ago
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Registered Nurse - Intensive Care Burn Unit - ICU - Travel RN

Healthcare Traveler Jobs
Missoula, MT
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2d ago
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Senior Program Manager

Providence Health & Services
Missoula, MT
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2d ago

RN

The Village Health & Rehabilitation
Missoula, MT
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2d ago
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CNA - - Sponsored Training Class 10/11/2021

Platinum Career Solutions
Missoula, MT
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2d ago
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Part-Time LPN

Hillside Health Care Center
Missoula, MT
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2d ago
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Registered Nurse Cardiac Cath Lab - Travel RN

Healthcare Traveler Jobs
Missoula, MT
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2d ago
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Full Time Jobs In Orchard Homes, MT