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Utilization Review Nurse
2 weeks ago
About us:
Good things are happening at Berkshire Hathaway GUARD Insurance Companies. We provide Property & Casualty insurance products and services through a nationwide network of independent agents and brokers. Our companies are all rated A+ “Superior” by AM Best (the leading independent insurance rating organization) and ultimately owned by Warren Buffett’s Berkshire Hathaway group – one of the financially strongest organizations in the world Headquartered in Wilkes-Barre, PA, we employ over 1,000 individuals (and growing) and have offices across the country. Our vision is to be a leading small business insurance provider nationwide.
Founded upon an exceptional culture and led by a collaborative and inclusive management team, our company’s success is grounded in our core values: accountability, service, integrity, empowerment, and diversity. We are always in search of talented individuals to join our team and embark on an exciting career path
Benefits:
We are an equal opportunity employer that strives to maintain a work environment that is welcoming and enriching for all. You’ll be surprised by all we have to offer
- Competitive compensation
- Healthcare benefits package that begins on first day of employment
- 401K retirement plan with company match
- Enjoy generous paid time off to support your work-life balance plus 9 ½ paid holidays
- Up to 6 weeks of parental and bonding leave
- Hybrid work schedule (3 days in the office, 2 days from home)
- Longevity awards (every 5 years of employment, receive a generous monetary award to be used toward a vacation)
- Tuition reimbursement after 6 months of employment
- Numerous opportunities for continued training and career advancement
- And much more
The Utilization Review Nurse's duties will include, but are not limited to:
- Support internal claims adjusting staff in the review of workers’ compensation claims
- Review records and requests for UR, which may arrive via mail, e-mail, fax, or phone
- Meet required decision-making timeframes
- Clearly document all communication and decision-making within our insurance software system
- Establish collaborative relationships and work as an intermediary between clients, patients, employers, providers, and attorneys
- Utilize good clinical judgment, careful listening, and critical thinking and assessment skills
- Track ongoing status of all UR activity so that appropriate turn-around times are met
- Maintain organized files containing clinical documentation of interactions with all parties of every claim
- Send appropriate letters on each completed UR
- Active Licensed Practical Nurse and/or Registered Nurse License
- 1+ years of utilization review experience at a managed care plan or provider organization
- 2 + years’ clinical experience preferably in case management, rehabilitation, orthopedics, or utilization review
- Excellent oral and written communication skills, including outstanding phone presence
- Strong interpersonal and conflict resolution skills
- Experience in a fast-paced, multi-faceted environment
- The ability to set priorities and work both autonomously and as a team member
- Well-developed time-management and organization skills
- Excellent analytical skills
- Working knowledge of: Microsoft Word, Excel, and Outlook
