Advanced Practice Registered Nurse (APRN)

Position Summary

The APRN provides psychiatric and addiction-focused medical care to clients receiving residential treatment at our ranch and lodge campuses. This role meets with clients for scheduled and as-needed medical appointments, completes psychiatric evaluations, and prescribes and manages medications for co-occurring mental health and substance use disorders.

This is the sole on-site prescribing provider role, and it is a traveling position. The APRN divides scheduled clinic time between our Ranch and Lodge campuses, holding client appointments at each site, and is supported by remote consulting physicians and a small on-site nursing team. Because on-site physician coverage is not available, the position requires a clinician who practices autonomously, exercises independent judgment, and is comfortable working with limited on-site nursing support.

Confidence and competence in medication-assisted treatment is the central requirement of this role. The APRN independently manages buprenorphine, naltrexone, and other approved medications for opioid and alcohol use disorder across the full client census, alongside psychotropic medication management for co-occurring mental health conditions.

Recovery Centers of Montana currently operates at ASAM Level 3.5 (clinically managed high-intensity residential). The organization intends to expand to ASAM Level 3.7 (medically monitored intensive inpatient) in the future, and this position will help build toward that transition as medical and nursing capacity grows.

Essential Duties and Responsibilities

Direct Client Care

• Meet with clients at the ranch and lodge for scheduled medical and psychiatric appointments, including admission assessments, follow-up visits, and urgent or same-day requests.

• Complete comprehensive psychiatric and substance use evaluations, including history, mental status examination, risk assessment, and diagnostic formulation using current DSM criteria and ASAM criteria.

• Prescribe, monitor, adjust, and discontinue psychotropic and addiction-related medications within the scope of Montana APRN licensure and prescriptive authority.

• Order, interpret, and act on laboratory studies, drug screens, and diagnostic tests; identify and manage medical conditions that commonly accompany substance use.

• Assess and respond to psychiatric crises, including suicidal or homicidal ideation, psychosis, and acute intoxication or withdrawal, and coordinate transfer to a higher level of care when clinically indicated.

• Educate clients and, with appropriate consent, families on diagnoses, medications, side effects, and the role of medication in sustained recovery.

Medication-Assisted Treatment and Medication Management

• Independently initiate, titrate, monitor, and taper buprenorphine for opioid use disorder, including induction planning and management of precipitated withdrawal risk.

• Prescribe and manage naltrexone (oral and extended-release injectable) and other approved medications for alcohol and opioid use disorder.

• Assess appropriateness of medication for each client, discuss options without bias toward any single modality, and document informed consent and shared decision-making.

• Oversee withdrawal management using standardized assessment protocols, in coordination with nursing staff, and determine when withdrawal severity exceeds the on-site level of care.

• Manage psychotropic medications for co-occurring depression, anxiety, PTSD, bipolar disorder, and psychotic disorders, including attention to interactions with MAT medications.

• Query the Montana Prescription Drug Registry as required, maintain DEA compliance, and follow written protocols for controlled substance prescribing and storage.

• Establish continuing MAT prescriptions and community pharmacy or provider linkage prior to discharge so that treatment is not interrupted.

Travel and Multi-Site Coverage

• Hold scheduled client appointments at both the Ranch and Lodge campuses according to an established weekly clinic schedule.

• Travel between campuses using personal or agency vehicle, with mileage reimbursed at the current agency rate.

• Remain reachable for medical consultation by phone or telehealth for the campus not staffed on a given day, and travel on site when clinically necessary, including within 24 hours of a new admission.

• Plan appointment scheduling and medication reviews so that clients at both sites receive timely follow-up despite split coverage.

Team Collaboration and Care Coordination

• Participate in treatment team meetings, staffings, and case reviews; contribute the medical and psychiatric perspective to individualized treatment planning.

• Serve as the on-site clinical resource for nursing staff, licensed addiction counselors, therapists, and support staff on medical and psychiatric questions.

• Write standing orders and protocols that guide nursing assessment, withdrawal monitoring, and escalation criteria between provider visits and across both campuses.

• Consult remote physicians for complex, high-acuity, or out-of-scope presentations, and escalate promptly when a case exceeds available on-site resources.

• Coordinate continuity of care with outside providers, hospitals, pharmacies, primary care, and community-based services at admission and discharge.

• Support discharge planning by establishing follow-up prescriptions, referrals, and aftercare medical arrangements.

Documentation and Compliance

• Complete timely, accurate, and legible documentation in the electronic health record, including evaluations, progress notes, medication orders, and treatment plan updates.

• Practice in accordance with the Montana Nurse Practice Act, DEA and prescription drug monitoring program requirements, 42 CFR Part 2, HIPAA, ASAM criteria, and applicable state licensing and accreditation standards.

• Follow agency policies and procedures, contribute to policy and protocol development, and participate in quality assurance, chart review, and performance improvement activities.

• Support survey and accreditation readiness activities as they relate to medical services and the transition to ASAM Level 3.7.

• Maintain client confidentiality and professional boundaries at all times.

Requirements

Minimum Qualifications

• Master’s degree or Doctorate in Nursing from an accredited institution.

• Current, unrestricted license to practice as an Advanced Practice Registered Nurse in the State of Montana, or eligibility to obtain licensure prior to hire.

• Current national certification as a Psychiatric Mental Health Nurse Practitioner (PMHNP-BC) through ANCC, or equivalent recognized certification.

• Active DEA registration, or eligibility to obtain, with authority to prescribe controlled substances, including buprenorphine.

• Demonstrated competence and comfort independently prescribing and managing medication-assisted treatment, including buprenorphine and naltrexone, without on-site physician oversight.

• Demonstrated knowledge of and specialization in addiction medicine, including withdrawal management and the medical complications of substance use.

• Current BLS certification.

• Valid Montana driver’s license with a good driving record and willingness to travel regularly between the Ranch and Lodge campuses.

• Ability to pass a background check and driver’s license check upon offer of employment.

Preferred Qualifications

• Two or more years of experience treating individuals with co-occurring serious mental illness and alcohol or drug addiction.

• Recovery Centers of Montana | APRN Job Description | Page 3

• Extensive training or experience in community-based or residential psychiatric treatment of individuals diagnosed with serious emotional disturbances or severe and persistent mental illness.

• Comprehensive and current knowledge of psychotropic medications, crisis intervention, and the appropriate use of hospital alternative services.

• Experience in an inpatient, residential, or ASAM Level 3.5 or higher setting.

• Experience with buprenorphine induction and extended-release injectable naltrexone in a residential or inpatient setting.

• Experience covering multiple sites or serving as a sole or lead prescriber in a behavioral health program.

• Experience supporting a program through expansion of its level of care or through an accreditation survey.

• Familiarity with rural and frontier behavioral health delivery, including telehealth and limited local specialty resources.

Knowledge, Skills, and Abilities

• Sound independent clinical judgment with a collaborative, team-oriented approach.

• Ability to build rapport quickly with clients who may be ambivalent, in early withdrawal, or distrustful of medical providers.

• Non-judgmental, trauma-informed, and recovery-oriented approach to care.

• Clear written and verbal communication with clients, families, staff, and outside providers.

• Strong organization and time management in a setting with shifting priorities and same-day clinical needs.

• Comfort with electronic health records and standard office software.

Schedule and Work Environment

• Five days per week on-site at the ranch and lodge residential campuses, with on-call or after-hours availability as arranged with the clinical director.

• Sole on-site prescribing provider, with remote physician consultation available. Significant clinical autonomy and corresponding responsibility for recognizing the limits of the on-site level of care.

• Split time between two rural campuses, with a small on-site nursing team. Comfort operating with limited on-site clinical support is essential.

• Rural campus setting; reliable transportation and comfort with seasonal driving in all Montana conditions are required.

• Regular contact with clients experiencing acute withdrawal, psychiatric distress, or behavioral escalation.

• Physical requirements include sitting, standing, and walking for extended periods, moving between buildings, and occasionally lifting up to 20 pounds.

Compensation and Benefits

• $55.00 – $60.00 per hour, dependent on education, licensure, and relevant addiction medicine experience.

• Medical, dental, and vision coverage.

• Paid time off and paid holidays.

• Relocation assistance available for qualified candidates.