Medical Resource Nurse

Berkshire Hathaway   •  

Omaha, NE

Industry: Accounting, Finance & Insurance

  •  

5 - 7 years

Posted 178 days ago

This job is no longer available.

WHO WE ARE

As a member of the Berkshire Hathaway group of insurance companies, we offer outstanding opportunities for professionals interested in working with a successful company. We offer unparalleled financial strength, stability and “large company” benefits, in addition to an exciting, friendly, “small company” atmosphere.

POSITION DESCRIPTION

A Medical Resource Nurse uses his/her advanced professional knowledge, education, training and experience to provide specialized technical expertise regarding medical information, advice, and training to Claims Professionals and Claims staff. The ideal candidate will have: their current RN license as well as 5+ years of recent, hands-on clinical experience in an acute care, medical surgery, emergency room, or other similar setting.

RESPONSIBILITIES

  • Provide expertise, advice and alerts to Claims Professionals and others regarding medical issues in claims including causation, diagnosis, prognosis, and the appropriateness and effectiveness of treatment; consulting initiated either upon request of the Claims Professional or pursuant to a program in which includes claims meeting certain specific criteria.
  • Develop or evaluate medical cost projections for use in claims reserving and settlement analysis, analyzing input from Medical Bill Review and Utilization Review to identify the likelihood and cost of possible future treatment; participate in roundtable discussions regarding these valuations.
  • Participate in strategic planning meetings regarding major claims, providing guidance and advice on the medical issues in the claims.
  • Facilitate discussion/review with Utilization Review and Claims Professionals tohelp monitor and guide the medical treatment provided to injured workers.
  • Advise Claims Professionals to ensure Field Case Nurses are assigned in appropriate claims in a timely manner, are given clear assignments, perform their work effectively and efficiently, and are removed from claims when their objectives have been met, or at the discretion of the Claims Professional.
  • Prepare and deliver training to Claims staff on a variety of advanced medical topics.
  • Assess and record the quality of services provided by medical providers in order to support the creation and continued improvement of high-quality provider panels and networks.
  • Foster a positive and close working relationship with other Company staff, including the adjusting staff, utilization review, medical bill review, special investigations, legal, lien resolution, the call center, and client services.
  • Maintain patient confidentiality and safeguard protected health information in accordance with state and federal laws and Company policies.
  • Attain and maintain a high level of current medical knowledge relating to the injuries and conditions most common in workers compensation claims, including new methods of diagnosis and treatment, as well as the treatment guidelines and other medical authorities relevant to the jurisdictions within the Medical Resource Nurse’s responsibilities.

QUALIFICATIONS

  • Certification and Education: Bachelor of Science Nursing degree (BSN); or Registered Nursing degree (RN), or Associate Nursing degree - with an active license.
  • Language Ability: Able to read, analyze, and interpret medical journals, statutes, regulations, medical reports, medical coding, medical bills, claim notes, claim data fields, financial reports, and legal documents. Able to respond to technical inquiries from Company employees, external sources, and regulatory or auditing entities.
  • Math Ability: Able to calculate figures and amounts such as discounts, interest, proportions, percentages, sums, differences, products, and volumes.
  • Reasoning Ability: Able to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Able to deal withproblems involving several concrete variables in standardized situations.
  • Technical Skills: Knowledge of current recognized evidence based medicine guidelines, office operations, workflow analysis, and current technologies in telecommunications, data entry, and file management.
  • Computer Skills: Knowledge of Microsoft Office software. Able to quickly master proprietary and vended software applications.

COMPREHENSIVE BENEFITS PACKAGE:

  • Health and wellness – low premiums for medical, dental and vision coverage, FSA and EAP benefits
  • Company paid Life, Disability and ADD benefits
  • Employee Retirement Savings Plan with employer match up to 5 percent of compensation
  • Generous Paid Time Off and Holidays
  • Education Assistance Reimbursement
  • Recognition and Rewards Programs
  • Company Store
  • Discounts across Berkshire Hathaway Inc. companies such as GEICO, See’s Candies, etc.

ABOUT US:

The Berkshire Hathaway Homestate Companies (BHHC) is a group of six insurance companies that are part of the Berkshire Hathaway Insurance Group. Our Workers Compensation Division provides premier workers compensation insurance coverage toemployers across the country, with offices in San Francisco, San Diego, Sacramento, Pasadena, Omaha, Philadelphia, St. Louis, Atlanta, and Dallas.