Utilization Review Nurse

Berkshire Hathaway   •  

Omaha, NE

Industry: Accounting, Finance & Insurance

  •  

Not Specified years

Posted 45 days ago

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

Are you looking for an opportunity to leverage your experience and increase your impact? Are you tired of hospital politics or working swing shifts and weekends? Berkshire Hathaway Homestate Companies has an immediate opportunity for experienced nurses with independent and critical thinking skills who are interested in helping injured workers get the care they need.

We have openings in our Omaha, Nebraska office for Utilization Review Nurses. The Utilization Review Nurse ensures all aspects of an injured worker's treatment are effective, efficient, and in accordance with applicable legal requirements.

This is a full-time, permanent position within our Medical Management team and that will allow experienced nurses to put their years of clinical knowledge to use in an office environment and learn new skills in this growing industry. No UR experience required!

The ideal candidate will have possess; A current RN license as well as 5+ years of recent, hands-on clinical experience an Acute care unit such as; Medical Surgery, Emergency Room, IUC, Oncology, Orthopedics, Neuro or other similar settings.

RESPONSIBILITIES

  • Review complex workers compensation medical treatment requests to ensure accordance with evidence-based medical treatment guidelines, which are generally recognized by the national medical community and are scientifically based.
  • Research claim file in relation to the requested medical treatment while interpreting medical reports/claims summaries and applies appropriate established guidelines to requested treatment. Refers treatment requests, which do not meet guidelines, for peer review and determination.
  • Advocate for the injured worker and claims department, ensuring proposed treatment requests are appropriate for the diagnosis.
  • Performs daily tasks within the appropriate established workflow processes, utilizes accepted guidelines and meets legislative and departmental timeframes.
  • Maintain patient confidentiality in discussions of treatment, disease process and conditions.
  • Routinely contacts providers to clarify treatment requests, examination findings, as well as obtain additional medical information as needed.
  • Maintains clear, concise, and accurate documentation of requested medical treatments to include clinical findings, treatment guidelines, and determination.
  • Provide appropriate notices to providers, injured workers, claims staff, and attorneys.
  • Act as a medical resource in regards to utilization review to Claims Support Nurse, Bill Review, and Claims department.
  • Foster a positive and close working relationship with other Company staff, including the claims staff, medical bill review, claims support nurse, special investigations, legal, liens, the call center, and client services.
  • Communicate effectively with individuals outside the company, including clients, medical providers, and vendors.

QUALIFICATIONS

  • Certification and Education: Bachelor of Science Nursing degree (BSN), or Registered Nursing degree (RN) from four-year college or university, or an accredited college. Must have an active state license and is eligible to obtain additional state licenses.
  • Experience: 5+ years of experience in acute care, emergency medicine, medical surgery, orthopedic practice or other medical environments where your experience could be applied to workers injured on the job.
  • Technical Skills: Knowledge of current recognized evidence-based medicine guidelines, office operations, workflow analysis, and current technologies in telecommunications, data entry, and file management.
  • Language Ability: Able to read, analyze, and interpret common scientific and technical journals, statutes, regulations, medical reports, medical coding, medical bills, financial reports, and legal documents. Able to respond to technical inquiries or complaints from Company employees, external sources, and regulatory or auditing entities.
  • Reasoning Ability: Able to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Able to deal with problems involving several concrete variables in standardized situations.
  • Computer Skills: Knowledge of Microsoft Office software. Able to perform independent internet medical research. 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 to employers across the country, with offices in San Francisco, San Diego, Sacramento, Pasadena, Omaha, Philadelphia, St. Louis, Atlanta, and Dallas.

As a member of the Berkshire Hathaway Insurance Group, BHHC has earned an enviable record of success in the insurance industry that is supported by an A++ A.M. Best rating for the last 10 consecutive years. Our corporate size enables our organization to react swiftly and effectively to opportunities in the insurance marketplace. At the same time, our financial strength provides our agents and insureds security and makes us one of the best brands in the marketplace.

We value each individual and recognize that attracting and retaining high-quality talent is essential to the success of our company. Our structure minimizes bureaucracy and creates an environment that encourages our employees to see the direct effects of their hard work throughout the company. Each division provides hands-on training and maintains a small company feel, creating an atmosphere in which 'team players' thrive.