Utilization Review Nurse

Writing a great utilization review nurse resume is important because it is one of the first things a potential employer will see when they are considering you for a position. It is your opportunity to make a good first impression and sell yourself as the best candidate for the job.

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If you're looking for inspiration when it comes to drafting your own utilization review nurse resume, look no further than the samples below. These resumes will help you highlight your experience and qualifications in the most effective way possible, giving you the best chance of landing the utilization review nurse job you're after.

Resume samples

Gai Knepp

gai.knepp@gmail.com | (821) 043-6289 | Detroit, MI

Summary


I am a Utilization Review Nurse with over 3 years of experience working in the field. I have a strong background in nursing and healthcare, and I am passionate about helping people get the care they need. I have a good understanding of insurance policies and procedures, and I know how to work with patients to ensure that they are getting the coverage they need.

Experience


Utilization Review Nurse at Blue Cross Blue Shield of Michigan, MIJun 2022 - Present

  • Reviewed medical records of assigned patients to determine the appropriateness and necessity of inpatient hospital services.
  • Utilized clinical knowledge and guidelines to make recommendations for patient care according to insurance benefits.
  • Communicated with physicians, case managers, and other members of the multidisciplinary team regarding utilization review decisions.
  • Monitored individual patient’s length of stay (LOS) and made necessary interventions to ensure efficient use of resources.
  • Successfully completed [number] reviews per day/week on average.

Utilization Review Nurse Manager at Health Alliance Plan, MIJul 2019 - Apr 2022

  • Reduced length of stay for patients by 10%.
  • Implemented a new utilization review process that saved the hospital $1 million annually.
  • Developed and implemented a discharge planning program that reduced readmissions by 20%.
  • Led a team of 15 Utilization Review Nurses in conducting daily reviews of patient charts to ensure appropriateness of care and level of acuity.
  • Monitored trends in resource utilization and made recommendations to senior leadership on ways to improve efficiency.

Education


Associate Degree in Nursing at Oakland Community College, MIAug 2014 - May 2019

I have learned how to work with patients, families, and other health care team members to provide quality care.

Skills


  • Medical Terminology
  • ICD-9/10 Coding
  • Utilization Management Principles
  • Care Coordination
  • Disease Processes and Treatment Options
  • Clinical Documentation Guidelines
  • Interqual Criteria

Yadira Linsangan

yadira.linsangan@gmail.com | (215) 117-4696 | 1423 Vassar Street, Saint Paul, MN 55104, USA

Summary


I am a Utilization Review Nurse with over 3 years of experience. I have worked in a variety of settings, including hospitals, clinics, and home health care agencies. I have a strong background in utilization review and discharge planning. I am skilled at working with insurance companies to get patients the coverage they need and deserve. I am also experienced in working with patients and families to ensure that they understand their treatment options and can make informed decisions about their care.

Experience


Utilization Review Nurse at Blue Cross Blue Shield of Minnesota, MNJun 2022 - Present

  • Reviewed patient records to ensure that insurance requirements were met and that treatment plans followed protocol.
  • Coordinated with doctors, nurses, and other staff members to verify patients’ health insurance coverage.
  • Monitored trends in utilization rates and made recommendations for improvement to the Director of Utilization Management.
  • Assisted in developing policies and procedures related to utilization management.
  • Trained new employees on proper utilization review techniques.

Utilization Review Nurse Manager at Medica, MNSep 2019 - May 2022

  • Reduced cost of care by 15% through effective utilization review.
  • Negotiated with insurance companies to get better coverage for patients.
  • Implemented new software that increased efficiency by 30%.
  • Trained staff on proper documentation and coding procedures.
  • Reviewed charts for 100+ patients per day.

Education


Associate Degree in Nursing at Metropolitan State University, MNAug 2014 - May 2019

I have learned how to provide care to patients, how to work with a team of nurses, and how to effectively communicate with patients and their families.

Skills


  • Utilization Review
  • Utilization Management
  • Medical Necessity Determination
  • Clinical Documentation Improvement
  • Care Coordination
  • Interqual Criteria
  • Milliman Guidelines