Utilization Review Nurse

Berkshire Hathaway Homestate Companies - Workers Compensation Division; Omaha (NE); Hybrid; USD 70,000 - 90,000; Full time

Benefits offered by this job

Work From Home (Up to 2 days per week)

Onsite Gym

Paid Time Off

Paid Holidays

Retirement Savings Match

Group Health Insurance

Tuition Reimbursement Program

Employee Referral Program

Job summary

A national insurance group in Omaha seeks a full-time Utilization Review Nurse to oversee treatment requests and ensure compliance with guidelines. Candidates should have a BSN or RN degree and at least 5 years of clinical experience in critical care. The role involves reviewing medical requests, advocating for injured workers, and maintaining accurate documentation. The position offers options for remote work, health insurance, and other competitive benefits.

Qualifications

• Current RN license with 5+ years of clinical experience in Critical care units.
• Ability to interpret medical reports, coding, and legal documents.
• Proficient in independent internet medical research.

Responsibilities

• Review workers compensation treatment requests against established guidelines.
• Advocate for injured workers and ensure treatment appropriateness.
• Maintain documentation of treatments and communicate with providers.

Skills

Clinical experience

Effective communication

Evidence-based practice knowledge

Microsoft Office proficiency

Education

Bachelor of Science Nursing degree (BSN) or RN

Tools

Proprietary medical software

Job description

What We're Looking For

We have openings in our Omaha, Nebraska office for Utilization Review Nurses. The Utilization Review Nurse ensures all aspects of an injured worker’s treatment are effective, efficient, and in accordance with applicable legal requirements. This is a full‑time, permanent position within our Medical Management team that allows experienced nurses to put their clinical knowledge to use in an office environment and learn new skills in this growing industry. No UR experience required!

Essential Responsibilities

• 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 apply appropriate established guidelines to the requested treatment. Refer treatment requests that do not meet guidelines to peer review and determination.
• Advocate for the injured worker and claims department, ensuring proposed treatment requests are appropriate for the diagnosis.
• Perform daily tasks within the appropriate established workflow processes, utilize accepted guidelines and meet legislative and departmental timeframes.
• Maintain patient confidentiality in discussions of treatment, disease process and conditions.
• Routinely contact providers to clarify treatment requests, examination findings, as well as obtain additional medical information as needed.
• Maintain clear, concise, and accurate documentation of requested medical treatments to include clinical findings, treatment guidelines, and determination.
• Provide appropriate notices to providers, injured workers, claims staff, and attorneys.
• Act as a medical resource in regards to utilization review to Claims Support Nurse, Bill Review, and Claims department.
• Foster a positive and close working relationship with other Company staff, including the claims staff, medical bill review, claims support nurse, special investigations, legal, liens, the call center, and client services.
• Communicate effectively with individuals outside the company, including clients, medical providers, and vendors.

What Will Set You Apart

• Education: Bachelor of Science Nursing degree (BSN), or Registered Nursing degree (RN) from four‑year college or university, or an accredited college.
• Licenses/Experience: A current RN license as well as 5+ years of recent, hands‑on clinical experience in a Critical care unit such as Medical Surgery, Emergency Room, ICU, Oncology, Orthopedics, Neuro or other similar settings. Must have an active state license and be eligible to obtain additional state licenses.
• Technical Skills: 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.
• Language Ability: Able to read, analyze, and interpret common scientific and technical journals, statutes, regulations, medical reports, medical coding, medical bills, financial reports, and legal documents. Able to respond to technical inquiries or complaints from Company employees, external sources, and regulatory or auditing entities.
• Reasoning Ability: 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.

What We Offer

• Work From Home (Up to 2 days per week upon eligibility)
• Onsite Gym
• Garage Parking
• Within walking distance of the Old Market District
• Paid Time Off
• Paid Holidays
• Retirement Savings Match
• Group Health Insurance (Medical, Dental, and Vision)
• Life and AD&D Insurance
• Long Term Disability Insurance
• 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, 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. 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.