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Internship Rn Utilization Review Nurse Jobs in Nebraska

P3 Health Partners

RN Care Manager

Lincoln, NE

$85K - $105K/yr

We are looking for a RN Care Manager . If you are passionate about your work; eager to have fun ... The Care Manager may be responsible for activities overlapping with utilization review and quality ...

P3 Health Partners

RN Care Manager

Lincoln, NE · On-site

$85K - $105K/yr

We are looking for a RN Care Manager . If you are passionate about your work; eager to have fun ... The Care Manager may be responsible for activities overlapping with utilization review and quality ...

Bryan Health

Care Transitions RN

Lincoln, NE · On-site

The Care Transitions RN conducts day-to-day activities for the clinical, psychosocial and ... Performs utilization review activities, including preadmission screening, insurance verification ...

Bryan Health

Care Transitions RN

Lincoln, NE

The Care Transitions RN conducts day-to-day activities for the clinical, psychosocial and ... Performs utilization review activities, including preadmission screening, insurance verification ...

Bryan Health

Care Transitions RN

Lincoln, NE

The Care Transitions RN conducts day-to-day activities for the clinical, psychosocial and ... Performs utilization review activities, including preadmission screening, insurance verification ...

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Internship Rn Utilization Review Nurse information

What are the key skills and qualifications needed to thrive as an Internship RN Utilization Review Nurse, and why are they important?

To thrive as an Internship RN Utilization Review Nurse, you need a solid foundation in nursing principles, clinical assessment, and case management, typically supported by an RN license and current enrollment in a nursing program. Familiarity with medical coding systems (like ICD-10 or CPT), electronic health records (EHRs), and utilization review software is often required. Strong analytical thinking, communication skills, and attention to detail set candidates apart in this role. These competencies are crucial for ensuring appropriate patient care, regulatory compliance, and effective resource utilization within healthcare organizations.

What types of tasks and learning experiences can I expect as an Internship RN Utilization Review Nurse?

As an Internship RN Utilization Review Nurse, you will typically assist experienced utilization review nurses in evaluating patient records, verifying the necessity of medical procedures, and ensuring compliance with insurance or regulatory guidelines. You'll gain exposure to interdisciplinary communication by collaborating with physicians, case managers, and insurance representatives. This role provides valuable insight into how clinical decisions impact both patient outcomes and healthcare costs, helping you develop analytical and communication skills essential for future advancement. Expect to participate in chart reviews, learn about medical necessity criteria, and attend case discussions as part of your hands-on learning.

What is an Internship RN Utilization Review Nurse?

An Internship RN Utilization Review Nurse is a registered nurse who is in a training or internship phase to learn how to evaluate the necessity, appropriateness, and efficiency of healthcare services provided to patients. This role involves reviewing patient records, coordinating with healthcare providers, and ensuring that treatments meet established guidelines and insurance requirements. The internship provides hands-on experience in the field of utilization review, helping nurses transition from direct patient care to a more administrative or case management-focused role. It is an entry-level opportunity for RNs interested in healthcare quality and cost management.

What is the difference between Internship Rn Utilization Review Nurse vs Utilization Review Nurse?

AspectInternship Rn Utilization Review NurseUtilization Review Nurse
CredentialsRN license, internship or training programRN license, certification in utilization review often preferred
Work EnvironmentTraining setting, supervised, learning-focusedClinical or office setting, independent review tasks
Job ResponsibilitiesAssisting in review processes, gaining experiencePerforming utilization reviews, making coverage decisions

Internship Rn Utilization Review Nurse is a training role for nursing students or new graduates gaining experience, while Utilization Review Nurse is a full-time professional responsible for evaluating medical necessity and coverage. The internship role focuses on learning, whereas the utilization review nurse performs independent assessments in healthcare settings.

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Internship Rn Utilization Review Nurse jobs near you

Utilization Review Nurse

Berkshire Hathaway Homestate Companies

Omaha, NE • Hybrid

Other

Medical, Dental, Vision, Life, PTO

Re-posted 22 days ago

Job description

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 treatment requests, which do not meet guidelines, for peer review and determination.
  • Advocate for the injured worker and claims department, ensuring proposed treatment requests are appropriate for the diagnosis.
  • Performs daily tasks within the appropriate established workflow processes, utilizes accepted guidelines and meets legislative and departmental timeframes.
  • Maintain patient confidentiality in discussions of treatment, disease process and conditions.
  • Routinely contacts providers to clarify treatment requests, examination findings, as well as obtain additional medical information as needed.
  • Maintains clear, concise, and accurate documentation of requested medical treatments to include clinical findings, treatment guidelines, and determination.
  • Provide appropriate notices to providers, injured workers, claims staff, and attorneys.
  • Act as a medical resource in regards to utilization review to Claims Support Nurse, Bill Review, and Claims department.
  • Foster a positive and close working relationship with other Company staff, including the claims staff, medical bill review, claims support nurse, special investigations, legal, liens, the call center, and client services.
  • Communicate effectively with individuals outside the company, including clients, medical providers, and vendors.
WHAT WILL SET YOU APART
  • EDUCATION: Bachelor of Science Nursing degree (BSN), or Registered Nursing degree (RN) from four-year college or university, or an accredited college.
  • LICENSES/EXPERIENCE: A current RN license as well as 5+ years of recent, hands-on clinical experience in a Critical care unit such as Medical Surgery, Emergency Room, ICU, Oncology, Orthopedics, Neuro or other similar settings. Must have an active state license and eligible to obtain additional state licenses.
  • TECHNICAL SKILLS: Knowledge of current recognized evidence-based medicine guidelines required. Proficient in Microsoft Office suite of applications. Able to perform independent internet medical research. Able to quickly master proprietary and vendor software applications.
  • LANGUAGE ABILITY: Able to read, analyze, and interpret common scientific and technical journals, statutes, regulations, medical reports, medical coding, medical bills, financial reports, and legal documents. Able to respond to technical inquiries or complaints from Company employees, external sources, and regulatory or auditing entities.
  • REASONING ABILITY: Able to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Able to deal with problems involving several concrete variables in standardized situations.
 
WHAT WE OFFER
  • Work From Home (Up to 2 days per week upon eligibility)
  • Onsite Gym
  • Garage Parking
  • Within walking distance of the Old Market District
  • Paid Time Off
  • Paid Holidays
  • Retirements Savings Match
  • Group Health Insurance (Medical, Dental, and Vision)
  • Life and AD&D Insurance
  • Long Term Disability Insurance
  • Paid Community Volunteer Day
  • Employee Assistance Program
  • Tuition Reimbursement Program
  • Employee Referral Program
  • Diversity, Equity and Inclusion Program
ABOUT US
With more than 50 years in business, Berkshire Hathaway Homestate Companies (BHHC) has grown from a regional organization to a national insurance group, offering insurance products from coast to coast. Relationships are the cornerstone of our culture, and we believe in doing the right thing. That means we invest in our business in every way possible to deliver on our mission and demonstrate that people are what powers our success. Our commitment to financial strength and integrity means our customers can rest assured that we will be there when it counts.
 
At BHHC we embrace diversity and foster an environment where our people can be their authentic selves. Our differences make us stronger and better together, which fosters a harmonious workplace-something we truly value. We've created an approachable and collaborative atmosphere. Here you'll find a welcoming workplace where everyone can feel valued, supported, and inspired to do great work. Together, we raise the bar by being curious, remaining customer-focused, and operating with integrity.
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