Berkshire Hathaway Homestate Companies

Utilization Review Nurse

Omaha, Nebraska · Full-time

Sponsorship not specifiedDetected 553 days ago

Code ReviewRESTAuditingAPI TestingICD-10ResearchMicrosoft Office

About the role

Our differences make us stronger and better together, which fosters a harmonious workplace-something we truly value.

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.
That means we invest in our business in every way possible to deliver on our mission and demonstrate that people are what powers our success.

No UR experience required!
Must have an active state license and eligible to obtain additional state licenses.
TECHNICAL SKILLS: Knowledge of current recognized evidence-based medicine guidelines required.

Knowledge of current recognized evidence-based medicine guidelines required.
Proficient in Microsoft Office suite of applications.
Able to perform independent internet medical research.
Able to quickly master proprietary and vendor software applications.
Able to respond to technical inquiries or complaints from Company employees, external sources, and regulatory or auditing entities.
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.

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.
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.
Act as a medical resource in regards to utilization review to Claims Support Nurse, Bill Review, and Claims department.
Communicate effectively with individuals outside the company, including clients, medical providers, and vendors.

With more than 50 years in business, Berkshire Hathaway Homestate Companies (BHHC) has grown from a regional organization to a national insurance group, offering insurance products from coast to coast.
Relationships are the cornerstone of our culture, and we believe in doing the right thing.
Our commitment to financial strength and integrity means our customers can rest assured that we will be there when it counts.
At BHHC we embrace diversity and foster an environment where our people can be their authentic selves.
We've created an approachable and collaborative atmosphere.
Here you'll find a welcoming workplace where everyone can feel valued, supported, and inspired to do great work.
Together, we raise the bar by being curious, remaining customer-focused, and operating with integrity.
ABOUT US With more than 50 years in business, Berkshire Hathaway Homestate Companies (BHHC) has grown from a regional organization to a national insurance group, offering insurance products from coast to coast.

This listing is sourced directly from Berkshire Hathaway Homestate Companies's careers page and normalized into a canonical job model.