Review precertification requests for medical necessity and refer those requests that require additional expertise to the medical Director. Review clinical information for concurrent reviews and extend lengths of stay as appropriate. Utilize effective relationship management, coordination of services, resource management, patient advocacy, education and related interventions. Provide appropriate consultation to patients and refer patients to case management personnel when necessary. Establish an effective rapport with other employees, customers, clients, patients, families, physicians and professional support service staff. Utilization review Manager, august 20 Monterey clinical Servicesâ monterey, ca prepared monthly cost savings and management reports and assisted with the preparation of quarterly summary reports. Maintained accurate records of all communications and interventions and provided timely verbal and written reports to icm staff as directed by the coo. Identified non-traditional resources and demonstrated creativity in managing each case to fully utilize all resources available to staff employees.
Utilization review Nurse resume sample nursing Resumes
The writing tips will help you choose skills to include, create your work history, gender and describe your education. Refer to the resume builder for even more information. Create, resume, olivia thyme 100 Broadway lane, new Parkland, ca, 91010, cell: (555) 987-1234. Professional Summary, utilization, review, manger competent at assuring the receipt of high quality and cost efficient medical outcomes. Identify the need for inpatient and outpatient precertification and preauthorization. Screen enrollees for icm programs. Core qualifications, review precertification requests. Determine medical necessity, admit referrals, clinical information, medical databases. Length of stay extensions, experience, utilization, review, manager, April 2012 Present, writing los Angeles Memorial Hospitalâ los Angeles,. Conduct ongoing availability, monitoring and oversight of non-clinical staff activities as part of the triage program.
remained on-call when insurance company need to review a medical claim quickly. Education 2004 Brickashaw State University, cobbler, ga certification, health Care management. As a utilization review manager, you understand the need for accuracy and high-quality results. Your resume should reflect this knowledge while emphasizing your specific skills and qualifications. This document should inspire hiring managers to take a closer look at your fitness for open positions. Throughout your career, you may have valuable opportunities to progress and advance; will your resume be up to the task? Use strong resumes, such as our utilization review manager resume sample, as examples while crafting your own. Our example resume offers a standard against essay which you might measure your own. It will help you determine the most effective types of formatting and the best practices for writing each section.
reported results to State board of Medicine. December 2010 to february 2012 Transitional Care for Seniors health Care facility. Cobbler, ga, utilization, review, nurse, worked with insurance companies to provide list of expected patient care services. contacted average of 10 insurance companies each week. Assesses time parameters for when patient is ready to return home. May 2012 to April 2014 Methodist Hospital for Children. Cobbler, ga, utilization, review, nurse, reviewed medical claims to compare service level to industry average. considered average of 17 shredder cases per day.
Specializes in reviewing cases for senior citizens. Highlights, attention to detail, microsoft Office. Filing, lifts more than 200 pounds, oracle database. Good phone skills, medicine standards or care, friendly. Written and spoken communication skills, work Experience, january 2008 to november 2010 Greater george peach Hospital. Cobbler, ga, utilization, review, nurse, reviewed client records to compare utilization levels to expected standards of care. Updated 1,239 medical records.
2 Utilization review Nurse resume samples - great Sample resume
Extensive experience in utilization review, quality assurance, discharge planning and other cost management programs. Wide knowledge of modern nursing did principles, techniques, your and procedures for the care of patients. Immense ability to demonstrates self motivation, time management and communication skills. Nursing Experience: Utilization Management Nurse, 2004 to till date good Samaritan Hospital, baltmore, md answered direct telephone calls related to medical services. Reviewed current inpatient services and determined medical appropriateness of inpatient and outpatient services. Advised and counseled to precertification staff.
Analyzed patient records, and participated in interdisciplinary collaboration with professional staff. Identified solutions to non-standard requests and problems. Academic Background health Care quality management board Certification, 2004 Rush University, chicago,. S in Nursing, 2003 University of Washington, seattle,. Michael taylor 2141 Button Hole avenue, cobbler, ga, 39002, cell: (555) 987-1234. Summary, utilization, review, nurse compares service levels with patient records to verify that all medical standards are being followed. Reviews files, updates records and discusses results with medical staff.
Developed relationships to help improve health outcomes for members. Ensured compliance to rules and regulation established by management. Documented review information in computer and communicated results to claims adjusters. Recorded and reported all information within scope of authority. Utilization, management, nurse, may 20, wellMed, dallas,. Implemented utilization management nursing functions.
Supervised current inpatient service management. Monitored medical interventions for inpatients. Provided healthcare benefits to patients via utilization management nursing services. Assisted and supported inpatients in obtaining finance and insurance benefits. Evaluated inpatient and outpatient services to determine medical appropriateness. Gathered and organized medical data to process medical benefits to patients. Education aa in health Care Administration, lake-sumter Community college, leesburg, fl example 2 Leslie serna 16987 w hammond St Kingsbury, tx 78638 (333) email protected Objective seeking to expand my experience as an Utilization Management Nurse and to enhance my skills competencies and to serve people. Solid organization, task prioritzation, and delegation skills.
Utilization review Nurse resume Example - bestSampleResume
Proficient in ms office suite and health care documentation systems (epoch, clinical Care Advance, med Decision). Strong communication and interpersonal skills, superior organization and time management skills. Outstanding ability to interpret business policies and procedures and communicate effectively. Remarkable ability to make decisions and exercise good judgment in a complex environment. Work Experience: Utilization, management, nurse, august 2005 Present, unitedHealth Group, dallas,. Maintained medical standards for all clients based on their individual health benefit plans. Conducted pre-certification, retrospective, out of network and appropriateness of treatment setting reviews within scope of licensure.
Telephonic utilization review and nursing support provided to the Injured Worker, Employer, Claims Examiner, Primary and Secondary Treating Physicians and any involved applicant or defense attorneys. Education Humboldt State University, ukiah,.,. Satellite Program (Graduate in top 5) 2000 healthcare management Training, gpa.5. 2000 Clinical Case management Certification 2001 Advanced Clinical Case management Certification. 2002 Legal Aspects of Nursing 2003 Advanced Concepts of Legal Nursing and healthcare *Personal References government available Upon Request. Teresa fay 1620 Whispering Pines Circle, dallas, tx 75247 (333) email, objective, to secure a position. Utilization, management, nurse in a premier medical center and to use my past experiences in the present work environment to better enhance the center. Summary of skills: Huge clinical care experience in health insurance industry. Deep knowledge of concurrent review, utilization management, and discharge planning, sound knowledge of Medicare and Milliman Care guidelines.
manager of peer review Services within 6 months from date of hire, expanding the initial peer reviewing staff from 3 reviewing physicians to 12 reviewing specialty physicians maintaining at least daily telephone contact in order to effectively manage all referred treatment requests;all treatment. Responsible to arrange peer-to-peer teleconference meetings as requested by treating physicians as well as resolution of any claims administration questions or concerns voiced by claims examiners. Bi-monthly coding and billing of peer review Invoices for each reviewing physician, in addition to physician reviewer payroll data to be reported. Increased monthly peer review Profit Margins from approximately 15,000 to an estimated average of 35,000 per month. @ lwp claims Solutions Sacramento,. Telephonic Nurse case manager Responsible for assessment and appropriate guidance of medically rendered treatment to comply with established guidelines. Concurrent Utilization review of post-operative or necessary skilled treatment to ensure appropriate equipment and services are provided to an eligible injured worker. Perform open and ongoing lines of communication between all involved parties, completion of research for potential appropriate treatment modalities, providing treatment options within guidelines to the injured worker and treating physician, in the event the injured workers progress towards an eventual return to work proves.
Coordinated work flow through several outlying offices and provided training and support for newly acquired contracted facilities as well as assisting and managing contracts undergoing any paper employee transitions. Reconciliation of utilization review and peer review billing cycles to include auditing of random utilization review file for compliance. Conducted ongoing educational meetings with staff to inform of any regulatory changes, as well as weekly 1:1 staff meetings to review audit findings, improvements needed or any concerns shared by the. Utilization, review, nurses and their support staff. Responsible to perform detailed file reviews on large exposure bill review files as requested by the bill. Performed some telephonic and field case management tasks as necessary while these programs were being established and implemented into new areas. Utilization, review, nurse and Manager of peer, review. Services, initially hired to function as a utilization review Nurse quickly excelling by exceeding established closure goal rates and providing ancillary team support necessary to achieve team review closure goals.
Utilization Management Nurse resume Example
Objective, to secure a challenging and rewarding position with a progressive. Utilization, review, program that will enable me to apply my cheerful and positive disposition teamed with an extensive workers Compensation and Clinical Case management experience base, to provide comprehensive, responsive, and professional risk management services, facilitating that Companys goal of superior service under the laws. Experience Schools Insurance authority sacramento,. Workers Compensation Services Early Intervention, nurse, responsible for Clinical Intake by gathering, receiving and documenting necessary information from a claimant or claimant representative in a contact center environment. Utilizing clinical knowledge to begin claim evaluation and pursue additional clarifying pertinent additional information that provides further insight mini into the claimant's clinical status and his or her ability to perform job duties. Completed claim data entry and correspondence as necessary for each newly reported injury. Maintained effective communication (both oral written) necessary to provide exceptional customer service. Allied Managed Care sacramento,. Utilization, review, nursing Manager, increased corporate claim review volume by 60 and stabilized core staff, which had previously demonstrated 100 employee turn-over rate within the first 4-6 months of employment.