Utilization Review Nurse

Berkshire Hathaway GUARD Insurance Companies provide Property & Casualty insurance products and services through a nationwide network of independent agents/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 the 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 and profit sharing
• Generous paid vacation and sick time
• Hybrid work schedule (three days in the office, two days from home)
• Work/life balance schedule – no nights or weekends/closed for all major holidays
• Longevity awards (every 5 years of employment receive a generous monetary award to be used toward a vacation)
• Tuition reimbursement after six months of employment
• Numerous opportunities for continued training and career advancement
• And much more!

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

• 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