Utilization Review Nurse

Join to apply for the Utilization Review Nurse role at Berkshire Hathaway GUARD Insurance Companies
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The position is open for the next week with 25 available slots.

We provide Property & Casualty insurance products through a nationwide network of independent agents and brokers. Our companies are rated A+ by AM Best and are owned by Berkshire Hathaway. Headquartered in Wilkes-Barre, PA, we employ over 1,000 individuals and have offices across the country. Our vision is to be a leading small business insurance provider nationwide.

Founded on an exceptional culture and led by a collaborative and inclusive management team, our success is grounded in our core values: accountability, service, integrity, empowerment, and diversity.

• Competitive compensation
• Healthcare benefits package that begins on the first day of employment
• 401K retirement plan with company match
• Generous paid time off to support 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)
• Tuition reimbursement after 6 months of employment
• Numerous opportunities for continued training and career advancement
• And much more

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

• Support internal claims adjusting staff in the review of workers’ compensation claims
• Review records and requests for utilization review, 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 act 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 to meet appropriate turnaround times
• Maintain organized files with clinical documentation of all claim interactions
• Send appropriate letters on each completed UR
• Work in one of our offices 3 days per week and be available for travel as required

$65,000 – $100,000 USD. The annual base salary range posted represents a broad range of salaries across 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.

• Active Licensed Practical Nurse and/or Registered Nurse license
• 1+ year(s) 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
• 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

• Entry level

• Full‑time

• Health Care Provider
• Insurance