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 is effective, efficient, and in accordance with applicable legal requirements.
- Manages complex workers compensation cases to ensure quality and clinical outcome is achieved through focused medical intervention.
- Advocate for the injured worker and claims department, ensuring proposed treatments requests are cost-effective and appropriate for the diagnosis.
- Performs daily tasks within the appropriate established workflow processes and utilizing accepted guidelines, and meeting legislative and departmental timeframes.
- Maintain patient confidentiality in discussions of treatment, disease process and conditions.
- Interprets medical reports/claims summaries and applies appropriate established guidelines to request. Refers requests, which do not meet guidelines for peer review and interpretation.
- Routinely contacts providers to clarify treatment requests, examination findings, as well as obtain additional medical information as needed.
- Maintains clear, concise, and accurate reporting of medical treatments, conditions, care plans, cost savings.
- Provide appropriate notices to providers, injured workers, claims staff, and attorneys.
- Act as a medical resource to the Managed Care, Bill Review, and Claims department.
- Foster a positive and close working relationship with other Company staff, including the claims staff, medical bill review, nurse case management, special investigations, legal, liens, the call center, and client services.
- Communicate effectively with individuals outside the company, including clients, medical providers, and injured workers.
- Certification and Education: Bachelor of Science Nursing degree (BSN); or Registered Nursing degree (RN), or Associate Nursing degree - Licensed Practical Nurse (LPN) with an active license from four-year college or university, an accredited college, or technical school, and one to two-years related experience and training; or equivalent combination of education and experience.
- 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, statues, 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.
COMPREHENSIVE BENEFITS PACKAGE:
- Disability and AD&D
- Retirement & Savings Plan with 100% employer match up to 5% of salary
- Education Assistance Reimbursement
- Paid Vacation and Holidays
The Berkshire Hathaway Homestate Companies (BHHC) is a group of six insurance companies that are part of the Berkshire Hathaway Insurance Group, headquartered in Omaha, Nebraska. Our Workers Compensation Division provides premier workers compensation insurance coverage to employers across the country, with offices in San Francisco, San Diego, Pasadena, Omaha, 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, the highest rating they award insurance carriers. 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 the security rarely available in a regional specialty carrier.
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.
BHHC - 17 months ago