Top 31 Referral specialist Jobs in Nebraska

Utilization Review Specialist
Berkshire Hathaway Homestate Companies —Omaha, NE
- Hybrid work
- Basic math
- Research
- Office
Quick Apply
12d
Customer Care Coordinator-Order Experience I
Numotion —Omaha, NE
- Overtime
- Microsoft Outlook
- Pass drug screening
- Office
- Disability insurance
- Health insurance
Prior Authorization Specialist
West Holt Medical Services —Atkinson, NE
- Full-time
- Mid-level
- Office
2d
Pharmacy & Medical Benefits Verification Specialist (Amber Specialty Pharmacy)
Amber Specialty Pharmacy —Omaha, NE
- Full-time
- Background check
- Microsoft Excel
- Microsoft Outlook
- Paid holidays
8d
Prior Authorization/Insurance Verification Representative
Lincoln Physical Therapy and Sports Rehab, LLC —Lincoln, NE
- From $19 an hour
- Part-time
- Medical office experience
- HIPAA
- In-person
- 401(k)
Quick Apply
Pre-Authorization Specialist
Cancer Partners of Nebraska —Lincoln, NE
- Full-time
- Medical office experience
- Mid-level
- Office
Quick Apply
Ambulatory Authorization Specialist
Mary Lanning Healthcare —Hastings, NE
- Full-time
- Mid-level
- 3 years
- High school diploma or GED
Authorization Specialist
Regional West Health Services —Scottsbluff, NE
- Full-time
- Hospital
- Pass drug screening
- HIPAA
Quick Apply
12d
Customer Care Coordinator
Numotion —Lincoln, NE
- Overtime
- Microsoft Outlook
- Pass drug screening
- Office
- Disability insurance
- Health insurance
Referral Coordinator
Lincoln Family Medical Group PC —Lincoln, NE
- Full-time
- HIPAA
- In-person
- Radiology
- Health insurance
- Dental insurance
Quick Apply
1d
Bryan Heart Pre-Authorization Specialist
Bryan Health —Lincoln, NE
- 8 hour shift
- Medical office experience
- Mid-level
- High school diploma or GED
Referral Specialist
Heartland Health Center —Grand Island, NE
- Full-time
- Background check
- Spanish
- HIPAA
- Health savings account
- Disability insurance
Quick Apply
5d
Employee Referral
Kidwell, Inc. —Lincoln, NE
- Entry level
Quick Apply
Information and Referral (I&R) Specialist
The Visiting Nurse Health Services —Omaha, NE
- $18.47 - $23.09 an hour
- Full-time
- Spanish
- Microsoft Outlook
- Computer literacy
Quick Apply
Payer Source Specialist-Outpatient, 40hrs/wk, Lincoln
Madonna Rehabilitation Hospital —Lincoln, NE
- Full-time
- Microsoft Outlook
- High school
- Mid-level
Referral Marketing Representative
Executive Home Care of Omaha —Omaha, NE
- Part-time
- Skilled nursing facility
- Mid-level
- Rehabilitation center
- Travel reimbursement
- Mileage reimbursement
Quick Apply
11d
Prior Authorization Specialist
Saunders Medical Center —Wahoo, NE
- Part-time
- Customer service
- Basic math
- HIPAA
Quick Apply
12d
Insurance Verification Representative, Part-Time - Nebraska Spine Hospital
SCA Health —Omaha, NE
- $16.88 - $30.53 an hour
- Part-time
- Bachelor's degree
- Entry level
- Disability insurance
- Health insurance
12d
Customer Service: Home Medical Supplies
CHI Health Saint Elizabeth —Lincoln, NE
- $15.67 - $22.14 an hour
- Full-time
- HIPAA
- Research
- High school diploma or GED
Insurance Processing Associate - BMT and CART Program
Nebraska Medicine —Omaha, NE
- 8 hour shift
- Microsoft Word
- Customer service
- Medical office experience
2d

I want to receive the latest job alert for referral specialist in nebraska

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

referral specialist jobs near nebraska

Customer Service Representative jobs in Lincoln, NE

Referral Specialist jobs in Omaha, NE

Utilization Review Nurse jobs in Omaha, NE

Marketing Representative jobs in Omaha, NE

Cart Attendant jobs in Omaha, NE

Referral Coordinator jobs in Lincoln, NE

Prior Authorization Specialist jobs in Lincoln, NE

Benefit Specialist jobs in Omaha, NE

Insurance Agent jobs in Omaha, NE

Aba Authorization jobs in Remote

Authorization Specialist jobs in Nutley, NJ

Authorization Specialist jobs in Kaiser, CA

Project Specialist jobs in Remote

Authorization Specialist jobs in Akron, OH

Authorization Specialist jobs in Dover, DE

Prior Authorization Specialist jobs in Nashville, TN

Customer Service Representative jobs in Cleveland, OH

Customer Service jobs in Rochester Hills, MI

Customer Service Representative jobs in San Jose, CA

Cabin Service jobs in Los Angeles International Airport, CA

Utilization Review Specialist

Berkshire Hathaway Homestate Companies -
Omaha, NE

Quick Apply

Job Details

12 days ago

Qualifications

Basic math
Employee relationship building
Productivity software
Technical Proficiency

Full Job Description

Berkshire Hathaway Homestate Companies, Workers Compensation Division, has an opening for a Utilization Review Specialist in Omaha to join its Medical Management team. The individual ensures that medical treatment requests from providers are medically appropriate and reviewed in compliance with State laws and Company policies.

ESSENTIAL RESPONSIBILITIES

Triages and manages intake coordination of requests for authorization and independent medical review requests.
Reviews authorization requests for approval in accordance with evidence-based medical treatment guidelines.
Researches claim files in relation to the requested medical treatment, interprets medical reports while utilizing critical thinking, and applies appropriate established guidelines to requested treatment.
Advocates for the injured worker and Claims department, ensuring proposed treatment requests are appropriate for the diagnosis.
Escalates treatment requests outside of authorization authority for review by a Utilization Review Specialist 2 or Utilization Review Nurse.
Ensures that utilization review processes are performed in accordance with the time limits and other requirements set by State law and Company policy.
Routinely contacts providers to clarify treatment requests and examination findings, as well as to obtain additional medical information as needed.
Gains and Maintains a thorough understanding of Company policies regarding the review of authorization requests by Utilization Review Specialists.
Establishes and maintains a close, positive communicative relationship and working partnership with Medical Bill Review staff to ensure effective and efficient integrated medical management of treatment provided to injured workers.
Fosters a positive and close working relationship with other Company staff, including adjusting staff, other Medical Management staff, Special Investigations Unit, Legal, Liens, Customer Care, and Client Services.
Maintains patient confidentiality and safeguards protected health information in accordance with State and Federal laws and Company policies.
Enters clear, concise, and accurate documentation of requested medical treatments, to include clinical findings, treatment guidelines, and determinations.
Ensures that appropriate notices are forwarded to medical providers, injured workers, Claims staff, and attorneys.
Provides general office or administrative support throughout the department.

QUALIFICATIONS

EDUCATION: Bachelor's or Associate's degree in a medical field from an accredited college or technical school required.
EXPERIENCE: Minimum of 6 months of relevant experience and/or training in a medical field, or equivalent combination of education and experience, required.
TECHNICAL SKILLS: Able to effectively use Microsoft Office/365 applications and able to become proficient in proprietary and vendor software applications.
LANGUAGE ABILITY: Able to read and understand basic documents, including statutes, regulations, medical records, medical bills, medical resource materials, claim notes, and claim data fields. Able to write clear, concise reports accurately conveying complex and nuanced information, as well as correspondence on medical and legal points. Able to effectively present information and respond to questions with adjusting staff, Management, and others.
MATH AND REASONING ABILITY: Able to solve practical problems and deal with a variety of variables in situations where only limited standardization exists. Able to interpret a variety of instructions furnished in written, oral, diagram, graph, or schedule form. Able to apply concepts such as addition, subtraction, multiplication, division, fractions, percentages, ratios, and proportions to practical situations. Ability to derive appropriate conclusions and apply on the job.

CORE COMPETENCIES

ATTENTION TO DETAIL

Double-checks the accuracy of information and work product to provide accurate and consistent work.
Completes all work according to procedures and standards.
Works in a conscientious, consistent, and thorough manner.

COMMUNICATION

Communicates and articulates clearly; is informative and appropriately concise.
Asks questions freely to broaden knowledge and skills.
Prepares clear and concise e-mails and other basic required written communications.

PROBLEM SOLVING & DECISION MAKING

Is objective; is able to evaluate facts apart from personal bias.
Identifies key decisions within area of responsibility and escalates tasks to appropriate authority as needed.
Effectively uses appropriate decision-making techniques.

Quick Apply

Refine Your Search

referral specialist jobs in nebraska

Utilization Review Specialist

Customer Care Coordinator-Order Experience I

Prior Authorization Specialist

Pharmacy & Medical Benefits Verification Specialist (Amber Specialty Pharmacy)

Prior Authorization/Insurance Verification Representative

Pre-Authorization Specialist

Ambulatory Authorization Specialist

Authorization Specialist

Customer Care Coordinator

Referral Coordinator

Bryan Heart Pre-Authorization Specialist

Referral Specialist

Employee Referral

Information and Referral (I&R) Specialist

Payer Source Specialist-Outpatient, 40hrs/wk, Lincoln

Referral Marketing Representative

Prior Authorization Specialist

Insurance Verification Representative, Part-Time - Nebraska Spine Hospital

Customer Service: Home Medical Supplies

Insurance Processing Associate - BMT and CART Program

I want to receive the latest job alert for referral specialist in nebraska

Explore jobs in more locations

ESSENTIAL RESPONSIBILITIES

QUALIFICATIONS

CORE COMPETENCIES

Job Seeker Tools

Employer Tools

Browse

Stay Connected