Utilization Review Nurse
US-NJ-Parsippany
careers
Req #: 5748
Type: Regular Full-Time
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Overview: 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 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! Responsibilities: 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 Salary Range $65,000.00 - $100,000.00 USD The successful candidate is expected to work in one of our offices 3 days per week and also be available for travel as required. The annual base salary range posted represents a broad range of salaries around the U.S. and is subject to many factors including but not limited to credentials, education, experience, geographic location, job responsibilities, performance, skills and/or training. 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
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