Utilization Management Nurse Resume

Teresa Fay

1620 Whispering Pines Circle

Dallas, TX 75247

(555)-555-5555

[email]

Objective To secure a position as an 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
• 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 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, TX

• 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.
• 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 2000 – July 2005

WellMed, Dallas, TX

• 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

Objective Seeking to expand my experience as an Utilization Management Nurse and to enhance my skills & competencies and to serve people

Career Profile:

• Excellent problem-solving and decision-making skills.
• Solid organization, task prioritzation, and delegation skills.
• Extensive experience in utilization review, quality assurance, discharge planning and other cost management programs.
• Wide knowledge of modern nursing principles, techniques, 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, IL

B.S in Nursing, 2003

University of Washington, Seattle, WA