Healthcare Utilization Review Specialist

Berkshire Hathaway Homestate Companies; Omaha (NE); On-site; USD 50,000 - 80,000; Full time

Job summary

Berkshire Hathaway Homestate Companies in Omaha is seeking a Utilization Review Specialist to join the Medical Management team. You will triage, review, and coordinate authorization requests to ensure medical treatments comply with state laws and company policies.

You will gather information from providers, apply evidence-based guidelines, and communicate decisions to involved parties while safeguarding patient confidentiality and delivering timely service.

Qualifications

• Education requirements: Bachelor's or Associate's degree in a medical field from an accredited program.
• Experience: Minimum 6 months in medical field or related training.
• Technical: Proficient with MS Office and able to learn vendor/proprietary software.

Responsibilities

• Triages and manages intake coordination of requests for authorization and independent medical review.
• Reviews authorization requests for approval using evidence-based guidelines.
• Researches claim files and interprets medical reports to apply guidelines to requested treatment.
• Maintains patient confidentiality in accordance with state and federal laws.

Skills

Attention to detail

Communication

Problem solving

Education

Bachelor's or Associate's degree in a medical field

Tools

MS Office

Vendor software

Job description

Berkshire Hathaway Homestate Companies in Omaha is seeking a Utilization Review Specialist to join the Medical Management team. You will triage, review, and coordinate authorization requests to ensure medical treatments comply with state laws and company policies.

You will gather information from providers, apply evidence-based guidelines, and communicate decisions to involved parties while safeguarding patient confidentiality and delivering timely service.