Utilization Review Nurse

1 day left

Location
Wilkes Barre, Pennsylvania
Salary
Not Specified
Posted
Mar 23, 2019
Closes
May 22, 2019
Ref
2072#GIJ--WestGuard.1
Category
Claims
Job Type
Not Specified
Career Level
Not Specified
Overview

Berkshire Hathaway GUARD Insurance Companies, an A+ Superior rated Insurance company is seeking a Utilization Review Nurse who is interested in joining a company with a unique culture dedicated to technology and customer service. Become part of our dynamic, growing managed care specialist team.

Responsibilities

  • 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

Qualifications

  • 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

About Us:

At Berkshire Hathaway GUARD Insurance Companies, we take great pride in bringing out the best in our employees guiding them along a career track of professional development and success!

Backed by our ultimate parent, Berkshire Hathaway Inc, we are aggressively expanding and enhancing our commercial lines products offerings with the goal of being the premier name for business insurance which creates opportunities for our staff!

Some Highlights of our Benefits are:

  • Excellent working hours (8am-4:30pm M-F).
  • Generous amount of vacation and sick time. Closed on all major holidays.
  • 401K with company match and profit sharing.
  • A competitive healthy package.
  • Tuition reimbursement after 6 months of employment.
  • Be part of Berkshire Hathaway, one of world's most admired companies. We offer opportunities to advance your career!

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