Utilization Review Nurse

Utilization Review Nurse –
Berkshire Hathaway GUARD Insurance Companies

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!

• Seniority level:
  Entry level
• Employment type:
  
  Full-time
• Job function:
  Health Care Provider
• Industry: Insurance

We are an equal opportunity employer that strives to maintain a work environment that is welcoming and enriching for all.

• 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 ½ 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!

• 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 time frames
• 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