Utilization Review Nurse (Workers Compensation)

Location: Omaha, Nebraska, United States; hybrid workplace with work-from-home up to 2 days per week upon eligibility

Company

hirify.global is a national insurance group providing insurance products across the United States.

What you will do

• Review complex workers compensation treatment requests against evidence-based medical guidelines and applicable legal requirements.
• Research claim files, interpret medical reports and claims summaries, and determine whether requested treatment is appropriate for the diagnosis.
• Refer treatment requests that do not meet established guidelines for peer review and determination.
• Contact medical providers to clarify treatment requests, examination findings, and additional medical information.
• Document clinical findings, treatment guidelines, and determinations clearly and accurately.
• Provide medical utilization review support and notices to providers, injured workers, claims staff, attorneys, and other stakeholders.

Requirements

• BSN or RN degree from a four-year or accredited college program.
• Current RN license and eligibility to obtain additional state licenses.
• At least 5 years of recent hands-on clinical experience in medical-surgical nursing, emergency care, ICU, oncology, orthopedics, neurology, or a similar setting.
• Knowledge of recognized evidence-based medical guidelines and the ability to perform independent medical research.
• Proficiency with Microsoft Office and the ability to quickly learn proprietary and vendor software.
• Ability to interpret scientific and technical journals, statutes, regulations, medical reports, coding, bills, financial reports, and legal documents.

Culture & Benefits

• Full-time, permanent position in an office-based Medical Management team.
• Paid time off and paid holidays.
• Retirement savings match.
• Group medical, dental, and vision insurance, plus life, AD&D, and long-term disability insurance.
• Onsite gym, garage parking, tuition reimbursement, employee assistance program, and a paid community volunteer day.
• Collaborative and inclusive workplace focused on integrity, customer service, and professional development.