North Dakota Workforce Safety & Insurance

The primary role of the Nurse Case Manager is to coordinate care and services for injured workers who are covered by North Dakota Workforce Safety & Insurance. Duties include:Manage a caseload average of 20 to 30 cases depending on severity. Respond to catastrophic or complex injuries as requested by the claims adjuster. Initiate contact with the injured worker, treating physician, and care providers to thoroughly report the extent of injuries to the claims adjuster.Conduct daytime travel to surrounding areas for on-site visits to physician offices, physical therapy programs, hospitals, etc., to coordinate medical services for the injured worker, and assist in coordinating medically related services.Serve as a medical resource to the claims adjuster, legal department, and Workforce Safety & Insurance employees and provide monthly reports to the claims department on each case being managed to document case progress.Develop and file case management plan, correspondence, and documentation and reviews and/or revisions as needed for each case.Provide professional-level analysis of medical-related information in client treatment, therapy medications, cost containment measures, etc.Must have a valid driver's license and be able to drive and maintain a State vehicle.Communicates clearly, effectively, and professionally to those internal and external to WSI.

Minimum Qualifications

Requires licensure as a Registered Nurse by the North Dakota Board of Nursing or licensure in another state and meets the eligibility requirements for licensure in North Dakota.One year of patient care RN work experience.

Preferred Qualifications

Excellent verbal and written communication skills.Ability to work effectively, professionally, and courteously with others both internal and external to the organization.Ability to effectively use PC software applications.Must exhibit strong leadership and problem-solving skills.Must be dependable, organized, self-motivated, resourceful, and flexible.Must be able to work independently with little supervision.North Dakota licensure is a condition of employment, and the employing agency will verify and document licensure upon appointment.

About Team ND

"Far and away the best prize life offers is the chance to work hard at work worth doing." - Theodore RooseveltMore than 7,500 talented, hard-working people across sixty-three agencies have come together as Team North Dakota. At Team ND, we are driven to succeed through gratitude, humility, curiosity and courage. Our purpose is to empower people, improve lives, and inspire success. Join us in being legendary.Total Rewards: The State of North Dakota is committed to providing team members with a strong and competitive rewards package that support you, your health and your family.Considering a new position on Team ND? How does your current position stack up? Use our Total Rewards Calculator to estimate.

Application Procedures

Apply online and upload the following information: cover letter (addressed to Human Resources), resume, and references. All application materials must be received by the closing date to be considered for the open position. Background checks will be conducted.WSI staff will score all applications based on a 100-point scoring and rating system. Applications should include information that directly addresses how the applicant meets the minimum qualifications and a . It is very important to be thorough and detailed in the application materials. Incomplete sections in the application will not be given credit.Applicants with disabilities should contact Denise Osmond at 701-328-3849 in advance of applying to discuss any special provisions needed for applying or interviewing.If you are experiencing technical difficulties with the Application Process or uploading attachments, please contact recruiter@nd.gov or 701-328-3290.ND Relay Number 1-800-366-6888.

Equal Employment Opportunity

The State of North Dakota and this hiring agency do not discriminate on the basis of race, color, national origin, sex (including sexual orientation and gender identity), genetics, religion, age or disability in employment or the provisions of services and complies with the provisions of the North Dakota Human Rights Act.As an employer, the State of North Dakota prohibits smoking in all places of state employment in accordance with N.D.C.C. Sect. 23-12-10.

Workforce Safety & Insurance is seeking a Medical Bill Auditor to review, process, and audit submitted medical billings to ensure appropriate reimbursement by WSI.The Medical Bill Auditor creates value and makes an impact with these job duties:Review and process medical bills according to national coding guidelines and established policies and procedures.Review medical documentation to confirm correct medical codes are submitted on the billed charges and documentation supporting the compensable injury.Confirm prior authorization requirements are met for services provided as appropriate.Ensure the WSI fee schedule or contracted agreement rate is applied correctly.Process approved adjustments and reconsideration requests; initiate adjustments when audit findings merit such action.Reporting suspected fraud and abuse.Maintain medical bill review manuals, policies, and procedures to ensure they reflect current laws and regulations.Review new medical procedures, technology, equipment, and medical codes to recommend coverage and reimbursement levels to the supervisor.Respond to provider inquiries with questions relating to coding, documentation, procedures, and payer requirements.Resolve provider reimbursement payment issues.

Minimum Qualifications

To prosper in this position, an associate degree in a health-related field and two years of work experience processing, auditing, or coding medical claims.Relevant work experience in processing, auditing, or coding medical claims may substitute for the education requirement on a year-for-year basis.

Preferred Qualifications

Current CPC Certification (Certified Professional Coder) or CPC certification eligible.Knowledge of the insurance industry, therapy coding, billing, or documentation.Confident, articulate, and professional verbal and written communication skills.Detail-oriented, problem-solving, and decision-making abilities.Dependable, organized, self-motivated, resourceful, and flexible.WSI holds our agency culture in high regard. The desired applicant must be engaging, professional, confident, forward-thinking, and supportive.

About Team ND

"Far and away the best prize life offers is the chance to work hard at work worth doing." - Theodore RooseveltMore than 7,500 talented, hard-working people across sixty-three agencies have come together as Team North Dakota. At Team ND, we are driven to succeed through gratitude, humility, curiosity and courage. Our purpose is to empower people, improve lives, and inspire success. Join us in being legendary.Total Rewards: The State of North Dakota is committed to providing team members with a strong and competitive rewards package that support you, your health and your family.Considering a new position on Team ND? How does your current position stack up? Use our Total Rewards Calculator to estimate.

Application Procedures

Apply online and upload the following information: cover letter (addressed to Human Resources), resume, references, and copy of college transcripts (if applicable). All application materials must be received by the closing date to be considered for the open position. Background checks will be conducted.WSI staff will score all applications based on a 100-point scoring and rating system. Applications should include information that directly addresses how the applicant meets the minimum qualifications and a . It is very important to be thorough and detailed in the application materials. Incomplete sections in the application will not be given credit.Applicants with disabilities should contact Denise Osmond at 701-328-3849 in advance of applying to discuss any special provisions needed for applying or interviewing.If you are experiencing technical difficulties with the Application Process or uploading attachments, please contact recruiter@nd.gov or 701-328-3290.ND Relay Number 1-800-366-6888.

Equal Employment Opportunity

The State of North Dakota and this hiring agency do not discriminate on the basis of race, color, national origin, sex (including sexual orientation and gender identity), genetics, religion, age or disability in employment or the provisions of services and complies with the provisions of the North Dakota Human Rights Act.As an employer, the State of North Dakota prohibits smoking in all places of state employment in accordance with N.D.C.C. Sect. 23-12-10.