utilization review nurse - Wilkes-Barre, PA , USA, United States - GUARD Insurance Group

Description

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.

Our organization is hiring and we're looking for talented individuals to join our team and establish a rewarding career with us.

Our success is founded on our strong reputation, and we have received an A+ Superior grade by the leading independent insurance rating organization.

If you're looking for an employer with integrity and flexibility, keep reading to learn about our benefits and job openings.

• Work life balance schedule- No Nights or Weekends
• Hybrid work schedule: Three days in the office, two days from home (if near one of our office locations)
• Generous vacation and sick time
• Closed on all major holidays
• Healthcare benefits begin on your first day of employment
• 401K with company match and profit sharing
• Every 5 years employees receive a generous monetary award to be used toward a vacation
• Tuition reimbursement after six months of employment
• Discover opportunities to advance your career
• Be part of Berkshire Hathaway Inc., one of the world's most admired companies

• 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

• 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