WHAT WE'RE LOOKING FOR
Berkshire Hathaway Homestate Companies, Workers Compensation Division, has an opening in our Omaha, Nebraska office for a Utilization Review Nurse. The Utilization Review Nurse is responsible for applying clinical expertise in reviewing requests for the authorization of medical treatment for injured workers, verifying medical appropriateness and ensures all aspects of an injured worker’s treatment are effective, efficient, and in accordance with applicable legal requirements. This individual will work closely with Utilization Review Specialists, the Medical Bill Review team, and Claims staff to ensure effective and efficient integrated management of treatment.
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 prior Utilization Review experience is required.
ESSENTIAL RESPONSIBILITIES
- Dispositions pending authorization requests that could not be approved by the Specialist team in alignment with State regulations, accepted treatment and Company guidelines. Performs a thorough review, ensuring appropriate documentation to facilitate timely response for those requests requiring determination by peer review physician.
- Reviews reconsiderations, internal appeals, concurrent reviews, and retrospective reviews as assigned in accordance with State regulations, accepted treatment and Company guidelines.
- Seeks to ensure that injured workers receive medical care that is safe, efficient, appropriate, and effective for their compensable work injuries.
- Gains and maintains a deep understanding of medical treatment guidelines, including ODG and ACOEM, and how those guidelines impact regulatory policy for various states.
- Fosters a positive working relationship with other Company staff, including Claims Adjusting, Nurse Case Management, Special Investigations, Claims Legal, Lien Unit, Client Services, and the Call Center.
- Maintains patient confidentiality and safeguards protected health information in accordance with State and Federal regulations and Company policy.
- Inquires with medical providers regarding clarification for authorization requests and coordinates communication with Claims Adjusting staff and others as necessary regarding treatment for injured workers.
- Ensures clear, concise, and accurate comments and information regarding diagnosis, treatment, care plans, decisions, and recommendations are documented timely within appropriate file/system.
- Ensures that appropriate notices are forwarded to medical providers, injured workers, Claims staff, and attorneys in connection with each determination.
REQUIRED QUALIFICATIONS
- EDUCATION: Bachelor of Science Nursing degree (BSN), Associate Degree in Nursing (ADN), or Registered Nursing degree (RN) from four-year college or university or an accredited college.
- LICENSES/CERTIFICATIONS: Nursing/RN - Registered Nurse - State Licensure and/or Compact State Licensure required; must be current and in good standing.
- EXPERIENCE: A minimum of five (5) years of nursing experience required, hospital nursing experience preferred.
- TECHNICAL SKILLS: Knowledge of current recognized evidence-based medicine guidelines, office operations, workflow analysis, and current technologies in telecommunications, data entry, and file management. Proficiency in Microsoft Office software and able to quickly master proprietary and vended software applications.
WHAT WE OFFER
- Work-Life Balance
- Work From Home Program (up to 2 days per week)
- Office Within Walking Distance of The Old Market
- Free On-Site Fitness Facility
- Garage Parking
BENEFITS
- Paid Time Off
- Paid Holidays
- Retirements Savings Match
- Group Health Insurance (Medical, Dental, and Vision)
- Life and AD&D Insurance
- Long Term Disability Insurance
- Accident and Critical Illness Insurance
- Flexible Savings Accounts
- Paid Community Volunteer Day
- Employee Assistance Program
- Tuition Reimbursement Program
- Employee Referral Program
- Diversity, Equity and Inclusion Program
ABOUT US
With more than 50 years in business, 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. 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. 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. Our differences make us stronger and better together, which fosters a harmonious workplace—something we truly value. 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.
DISCLAIMERS
This job posting is not intended as an exhaustive listing of responsibilities and qualifications. A copy of the job description is available upon request. The Work from Home Program is subject to certain eligibility requirements.
