Hiring: Utilization Review Specialist Company: Berkshire Hathaway Homestate Companies - Workers Compensation Division Location: Omaha, NE Job Posted Time: 2026-09-16 15:12:47 Target Skills & Keywords : Microsoft Office, Utilization Review About the job Required Skills: •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. Qualifications: •TECHNICAL SKILLS: Able to effectively use Microsoft Office/365 applications and able to become proficient in proprietary and vendor software applications. •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. •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. Interested candidates, please apply directly through the job posting on company's career page or try via AI auto apply on this platform. Don't miss this opportunity to join a forward-thinking team!