Top 36 Utilization review Jobs in Omaha, Ne

Utilization Review Specialist
Berkshire Hathaway Homestate Companies —Omaha, NE
- Hybrid work
- Basic math
- Research
- Office
Quick Apply
Nurse Disability Consultant
Lincoln Financial —Omaha, NE
- $72,900 - $131,600 a year
- Online Application
- Remote
- Nursing
- RN License
- Mid-level
- Disability insurance
- Tuition reimbursement
Utilization Review Nurse
Berkshire Hathaway Homestate Companies —Omaha, NE
- Full-time
- Hybrid work
- Nursing
- RN License
- 5 years
- Free parking
- AD&D insurance
Quick Apply
Manager Utilization Management
P3 Health Partners —Omaha, NE
- $100,000 - $140,000 a year
- Hybrid work
- Nursing
- Microsoft Excel
- Microsoft Outlook
Quick Apply
9d
Physical Therapist - Outpatient & Inpatient positions
Madonna Rehabilitation Hospital —Omaha, NE
- Full-time
- CPR Certification
- BLS Certification
- Physical & Rehabilitation Medicine
- Health savings account
- Disability insurance
Quick Apply
Staff Pharmacist- Part Time
All Care Health Center —Council Bluffs, IA
- $60 - $65 an hour
- Part-time
- Bachelor of Science
- Mid-level
- Clinic
Quick Apply
Utilization Management Nurse
Detego Health —Omaha, NE
- $75,000 - $85,000 a year
- Full-time
- RN License
- Mid-level
- Office
Quick Apply
3d
Registered Home Healthcare and Hospice Nurse
Prime Home Care, LLC —La Vista, NE
- $35 - $44 an hour
- Full-time
- Nursing
- RN License
- HIPAA
- Health insurance
- Dental insurance
Quick Apply
Clinical Intake Specialist
Hillcrest Health Services —Bellevue, NE
- Full-time
- Remote
- Nursing
- RN License
- HIPAA
- Health insurance
- Dental insurance
Quick Apply
2d
Clinical Documentation Specialist
Nebraska Methodist Health System —Council Bluffs, IA
- Full-time
- Nursing
- RN License
- Hospital
RN Care Manager - Omaha Market
ArchWell Health —Omaha, NE
- Full-time
- Nursing
- RN License
- Mid-level
Home Care Field Supervisor for Veterans
Live Well Home Care —Omaha, NE
- $50,000 a year
- Full-time
- Management
- Mid-level
- Office
Quick Apply
9d
Admissions Social Worker - Evenings
Methodist Jennie Edmundson Behavioral Health Hospital —Council Bluffs, IA
- Full-time
- Acute care
- CPR Certification
- Nursing
Board Certified Behavior Analyst (BCBA) - Remote
All Care Therapies —Omaha, NE
- $43 - $56 an hour
- Part-time
- HIPAA
- Psychology
- Mentoring
Quick Apply
14d
Medicare Medical Director
Blue Cross and Blue Shield of Nebraska (BCBSNE) —Omaha, NE
- Full-time
- Medicine
- 7 years
- BC/BE
Director of Clinical Informatics (RN) - Vetter Senior Living
Vetter Senior Living —Elkhorn, NE
- Full-time
- RN License
- Travel
- Senior level
Quick Apply
Physical Therapy Assistant
Charter Healthcare —Omaha, NE
- $19.75 - $25.00 an hour
- Full-time
- BLS Certification
- Physical & Rehabilitation Medicine
- Driver's License
Quick Apply
Home Health Clinical Manager
Centerwell —Omaha, NE
- $69,500 - $95,600 a year
- Full-time
- CPR Certification
- Nursing
- RN License
- Paid parental leave
- Paid holidays
Physical Therapist Outpatient - Omaha (9am-5:30pm, FT, Mon-Fri)
Madonna Rehabilitation Hospital —Omaha, NE
- Full-time
- CPR Certification
- Clean driving record
- Doctoral degree
Therapist I - Bluffside Men's Recovery
Heartland Family Service —Council Bluffs, IA
- $50,000 - $63,255 a year
- Full-time
- Clean driving record
- Mid-level
- Residential
Quick Apply

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Utilization Review Specialist

Berkshire Hathaway Homestate Companies -
Omaha, NE

Quick Apply

Job Details

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

utilization review jobs in omaha, ne

Utilization Review Specialist

Nurse Disability Consultant

Utilization Review Nurse

Manager Utilization Management

Physical Therapist - Outpatient & Inpatient positions

Staff Pharmacist- Part Time

Utilization Management Nurse

Registered Home Healthcare and Hospice Nurse

Clinical Intake Specialist

Clinical Documentation Specialist

RN Care Manager - Omaha Market

Home Care Field Supervisor for Veterans

Admissions Social Worker - Evenings

Board Certified Behavior Analyst (BCBA) - Remote

Medicare Medical Director

Director of Clinical Informatics (RN) - Vetter Senior Living

Physical Therapy Assistant

Home Health Clinical Manager

Physical Therapist Outpatient - Omaha (9am-5:30pm, FT, Mon-Fri)

Therapist I - Bluffside Men's Recovery

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