We have an opening in our Omaha, Nebraska office for a Utilization Review Specialist. The Utilization Review Specialist enters requests for the authorization of medical treatment from medical providers treating injured workers and reviews them for approval in accordance with company policies.
Enters authorization requests into the utilization review software, ensuring they are complete, accurate, and associated with the correct claim.
Reviews authorization requests for approval in accordance with company policies and information contained in the claim file.
Forwards authorization requests to Utilization Review Nurses.
Processes reconsiderations, internal appeals, concurrent reviews, and retrospective reviews in accordance with company policies.
Ensures that utilization review processes are performed in conformance with the time limits and other requirements set by state law and company policy.
Gains and maintains a thorough understanding of company policies regarding the review of authorization requests by Utilization Review Specialists.
Establishes and maintains a close, positive communication relationship and working partnership with Medical Bill Review staff to ensure effective and efficient integrated medical management of treatment provided to injured workers.
Fosters a positive and close working relationship with other Company staff, including the claims staff, nurse case management, special investigations, legal, liens, the call center, and client services.
Maintains patient confidentiality and safeguards protected health information in accordance with state and federal laws and company policies.
Enters clear, concise, and accurate comments and information regarding diagnosis, treatment, care plans, decisions, and recommendations.
Ensures that appropriate notices are forwarded to medical providers, injured workers, claims staff, and attorneys.
BA, BS, or Associates degree from an accredited college or technical school in a medical field; or at least six months of relevant experience and training in a medical field; or an equivalent combination of education and experience.
Computer Skills: Knowledge of Microsoft Office software. Able to quickly master proprietary and vended software applications.
COMPREHENSIVE BENEFITS PACKAGE:
Disability and AD&D
Retirement & Savings Plan with 100% employer match up to 5% of salary
Education Assistance Reimbursement
Paid Vacation, Sick Time 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.