Registered Nurse (RN) - Utilization Review
GUARD Insurance Group
Wilkes Barre, PA

Utilization Review Nurse

Overview Utilization Review Nurse 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. Become part of our dynamic, growing managed care specialist team. Berkshire Hathaway GUARD offers a collaborative company culture with outstanding benefits and competitive compensation. 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. Backed by our ultimate parent company, Berkshire Hathaway Inc., our brand is founded upon trust, service, and innovation. If you're looking for an employer with integrity and flexibility, keep reading to learn about our benefits and job openings. Benefits: * 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 Responsibilities * 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 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