2 senior staff attorney jobs found in Omaha, NE

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...

WHAT WE'RE LOOKING FOR We have openings in our Omaha, Nebraska office for Utilization Review Nurses. The Utilization Review Nurse ensures all aspects of an injured worker’s treatment are effective, efficient, and in accordance with applicable legal requirements. This is a full-time, permanent position within our Medical Management team and that will allow experienced nurses to put their years of clinical knowledge to use in an office environment and learn new skills in this growing industry. No UR experience required!   ESSENTIAL RESPONSIBILITIES Review complex workers compensation medical treatment requests to ensure accordance with evidence-based medical treatment guidelines, which are generally recognized by the national medical community and are scientifically based. Research claim file in relation to the requested medical treatment while interpreting medical reports/claims summaries and applies appropriate established guidelines to requested treatment. Refers...