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utilization review nurse: Resume Samples & Writing Guide
Employment history
Chief Utilization Review Nurse, Advocate Aurora Health Chicago, Illinois
October 2017 – Present
- Participate in quality assurance activities
- Monitor patient care for quality and appropriateness of services
- Develop and maintain utilization review policies and procedures
Utilization Review Nurse, Cleveland Clinic Cleveland, Ohio
March 2017 – September 2017
- Review medical records to ensure that services are medically necessary
- Document all utilization review activities in accordance with regulations
- Facilitate discharge planning and coordinate care transitions
Junior Utilization Review Nurse, Mayo Clinic Rochester, Minnesota
March 2016 – February 2017
- Review medical records to ensure that services are medically necessary
- Collaborate with physicians, case managers, and other members of the healthcare team
- Evaluate the need for continued care and recommend appropriate changes
Education
University of Michigan Medical School, Ann Arbor, Michigan
Bachelor of Science in Health Sciences, January, 2016
Skills
Adaptability
Networking
Reporting
Project Management
Chart Auditing
Claims Processing
ICD-10 Coding
Disease Management
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Employment history
Senior Utilization Review Nurse, Mount Sinai Health System New York City, New York
April 2018 – Present
- Educate providers and other staff on utilization review processes
- Review medical records to ensure that services are medically necessary
- Evaluate the need for continued care and recommend appropriate changes
Associate Utilization Review Nurse, Mayo Clinic Rochester, Minnesota
October 2017 – March 2018
- Document all utilization review activities in accordance with regulations
- Develop utilization review plans and ensure compliance with regulations
- Evaluate the need for continued care and recommend appropriate changes
Junior Utilization Review Nurse, Kaiser Permanente Oakland, California
April 2016 – September 2017
- Review medical records to ensure that services are medically necessary
- Participate in quality assurance activities
- Verify insurance coverage and authorization for services
Education
Duke University School of Medicine, Durham, North Carolina
Master of Science in Public Health, February, 2016
Duke University School of Medicine, Durham, North Carolina
Bachelor of Science in Biomedical Engineering, February, 2012
Skills
Presentation
Social Media
Adaptability
Stress Management
HIPAA Compliance
Medical Record Review
Medical Billing
Disease Management
Professional Summary
Utilization Review Nurse with extensive experience in the medical field. Proven ability to ensure quality patient care while staying within budget and regulatory guidelines.
Employment history
Chief Utilization Review Nurse, Baylor Scott & White Health Dallas, Texas
December 2011 – Present
- Provide clinical expertise in the review of medical services
- Perform concurrent and retrospective review of medical services
- Develop and maintain utilization review policies and procedures
Associate Utilization Review Nurse, NYU Langone Health New York City, New York
December 2010 – November 2011
- Monitor patient care for quality and appropriateness of services
- Verify insurance coverage and authorization for services
- Develop and maintain utilization review policies and procedures
Jr. Utilization Review Nurse, Kaiser Permanente Oakland, California
December 2009 – November 2010
- Develop utilization review plans and ensure compliance with regulations
- Verify insurance coverage and authorization for services
- Provide clinical expertise in the review of medical services
Education
Johns Hopkins University School of Medicine, Baltimore, Maryland
Certified Medical Receptionist, October, 2009
Skills
Teamwork
Collaboration
Conflict Resolution
Business Acumen
Computer Proficiency
Medical Terminology
Utilization Management
Regulatory Compliance
Professional Summary
Seasoned Utilization Review Nurse with extensive experience in the medical field. Skilled in assessing patient needs, developing plans of care, and working collaboratively with multidisciplinary teams to coordinate effective care.
Employment history
Senior Utilization Review Nurse, Mount Sinai Health System New York City, New York
April 2013 – Present
- Analyze and interpret utilization data to identify trends and cost savings opportunities
- Participate in quality assurance activities
- Perform concurrent and retrospective review of medical services
Utilization Review Nurse, Johns Hopkins Medicine Baltimore, Maryland
April 2012 – March 2013
- Develop utilization review plans and ensure compliance with regulations
- Facilitate discharge planning and coordinate care transitions
- Document all utilization review activities in accordance with regulations
Jr. Utilization Review Nurse, Advocate Aurora Health Chicago, Illinois
September 2011 – March 2012
- Communicate findings and recommendations to appropriate parties
- Review medical records to ensure that services are medically necessary
- Develop and maintain utilization review policies and procedures
Education
Stanford School of Medicine, Stanford, California
Doctor of Health Administration, August, 2011
Stanford School of Medicine, Stanford, California
Bachelor of Science in Medical Laboratory Science, August, 2007
Skills
Attention to Detail
Professionalism
Problem Solving
Research
Quality Assurance
Healthcare Reimbursement
Insurance Verification.
Medical Record Review
Employment history
Senior Utilization Review Nurse, Kaiser Permanente Oakland, California
August 2020 – Present
- Develop and maintain utilization review policies and procedures
- Verify insurance coverage and authorization for services
- Collaborate with physicians, case managers, and other members of the healthcare team
Associate Utilization Review Nurse, Providence St. Joseph Health Renton, Washington
August 2019 – July 2020
- Facilitate discharge planning and coordinate care transitions
- Develop and maintain utilization review policies and procedures
- Participate in quality assurance activities
Entry Level Utilization Review Nurse, NYU Langone Health New York City, New York
January 2019 – July 2019
- Review medical records to ensure that services are medically necessary
- Facilitate discharge planning and coordinate care transitions
- Analyze and interpret utilization data to identify trends and cost savings opportunities
Education
Duke University School of Medicine, Durham, North Carolina
Bachelor of Science in Occupational Therapy, December, 2018
Skills
Training
Reporting
Negotiation
Organization
Utilization Management
Quality Assurance
Healthcare Regulations
Regulatory Compliance
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utilization review nurse Job Descriptions; Explained
If you're applying for an utilization review nurse position, it's important to tailor your resume to the specific job requirements in order to differentiate yourself from other candidates. Including accurate and relevant information that directly aligns with the job description can greatly increase your chances of securing an interview with potential employers.
When crafting your resume, be sure to use action verbs and a clear, concise format to highlight your relevant skills and experience. Remember, the job description is your first opportunity to make an impression on recruiters, so pay close attention to the details and make sure you're presenting yourself in the best possible light.
1
utilization review nurse
- Review individual records and conduct utilization reviews for precertification, continued stay and discharge.
utilization review nurse Job Skills
For an utilization review nurse position, your job skills are a key factor in demonstrating your value to the company and showing recruiters that you're the ight fit for the role. It's important to be specific when highlighting your skills and ensure that they are directly aligned with the job requirements, as this can greatly improve your chances of being hired. By showcasing your relevant skills and experience, you can make a compelling case for why you're the best candidate for the job.
How to include technical skills in your resume:
Technical skills are a set of specialized abilities and knowledge required to perform a particular job
effectively. Some examples of technical skills are data analysis, project management, software proficiency,
and programming languages, to name a few.
Add the technical skills that will get hired in your career
field with our simple-to-use resume builder. Select your desired resume template, once you reach the skills
section of the builder, manually write in the skill or simply click on "Add more skills". This will
automatically generate the best skills for your career field, choose your skill level, and hit "Save &
Next."
- Medical Terminology
- Clinical Documentation
- ICD-10 Coding
- Medical Record Review
- Clinical Assessment
- Utilization Management
- CPT Coding
- Quality Assurance
- Disease Management
- HIPAA Compliance
- Chart Auditing
- Computer Proficiency
- Regulatory Compliance
- Risk Management
- Healthcare Regulations
- Medical Billing
- Claims Processing
- Patient Advocacy
- Healthcare Reimbursement
- Insurance Verification.
How to include soft skills in your resume:
Soft skills are non-technical skills that relate to how you work and that can be used in any job. Including
soft skills such as time management, creative thinking, teamwork, and conflict resolution demonstrate your
problem-solving abilities and show that you navigate challenges and changes in the workplace
efficiently.
Add competitive soft skills to make your resume stand-out to recruiters! Simply select
your preferred resume template in the skills section, enter the skills manually or use the "Add more skills"
option. Our resume builder will generate the most relevant soft skills for your career path. Choose your
proficiency level for each skill, and then click "Save & Next" to proceed to the next section.
- Communication
- Interpersonal
- Leadership
- Time Management
- Problem Solving
- Decision Making
- Critical Thinking
- Creativity
- Adaptability
- Teamwork
- Organization
- Planning
- Public Speaking
- Negotiation
- Conflict Resolution
- Research
- Analytical
- Attention to Detail
- Self-Motivation
- Stress Management
- Collaboration
- Coaching
- Mentoring
- Listening
- Networking
- Strategic Thinking
- Negotiation
- Emotional Intelligence
- Adaptability
- Flexibility
- Reliability
- Professionalism
- Computer Literacy
- Technical
- Data Analysis
- Project Management
- Customer Service
- Presentation
- Written Communication
- Social Media
- Troubleshooting
- Quality Assurance
- Collaboration
- Supervisory
- Risk Management
- Database Management
- Training
- Innovation
- Documentation
- Accounting
- Financial Management
- Visualization
- Reporting
- Business Acumen
- Process Improvement
- Documentation
- Relationship Management.
How to Improve Your utilization review nurse Resume
Navigating resume pitfalls can mean the difference between landing an interview or not. Missing job descriptions or unexplained work history gaps can cause recruiters to hesitate. Let's not even talk about the impact of bad grammar, and forgetting your contact info could leave your potential employer hanging. Aim to be comprehensive, concise, and accurate.
Employment history
Chief Utilization Review Nurse, Kaiser Permanente Oakland, California
March 2011 – May 2022
- Verify insurance coverage and authorization for services
- Communicate findings and recommendations to appropriate parties
- Analyze and interpret utilization data to identify trends and cost savings opportunities
Utilization Review Nurse, Providence St. Joseph Health Renton, Washington
September 2010 – March 2011
- Analyze and interpret utilization data to identify trends and cost savings opportunities
- Facilitate discharge planning and coordinate care transitions
- Perform concurrent and retrospective review of medical services
Entry Level Utilization Review Nurse, Kaiser Permanente Oakland, California
March 2009 – August 2010
Education
University of California San Francisco School of Medicine, San Francisco, California
Doctor of Medicine, February, 2009
University of California San Francisco School of Medicine, San Francisco, California
Bachelor of Science in Health Sciences, February, 2005
Skills
Problem Solving
Adaptability
Accounting
Negotiation
Disease Management
Healthcare Reimbursement
Claims Processing
Clinical Assessment
Unexplained Year Gaps and Missing Job Experiences are a No-no
Gaps in your resume can prevent recruiters from hiring you if you don't explain them.
Key Insights- It's okay to have gaps in your work experience but always offer a valid explanation instead of just hiding it.
- Use the gap to talk about positive attributes or additional skills you've learned.
- Be honest and straightforward about the gap and explain it using a professional summary.
How to Optimize Your utilization review nurse Resume
Keep an eye out for these resume traps. Neglecting to detail your job roles or explain gaps in your career can lead to unnecessary doubts. Grammar blunders can reflect negatively on you, and without contact information, how can employers reach you? Be meticulous and complete.
Isaac King 515 Riverview Avenue, Dollar Bay, MI 49922
Employment history
Chief Utilization Review Nurse, Mount Sinai Health System New York City, New York
November 2022 – Present
- Facilitate discharge planing, and coordiante care transtions.
- Perform concurrent, and retrospective review of medical servies.
- Verfiy insurance coverage, and authoriztion for servies.
Associate Utilization Review Nurse, Advocate Aurora Health Chicago, Illinois
May 2021 – October 2022
- Perform concurrent and retrospectiv review of medical services
- Educate providers and other staff on utilizaiton review processes
- Proivde clinical expertise in the review of medical services
Entry Level Utilization Review Nurse, Mount Sinai Health System New York City, New York
November 2020 – April 2021
- Evaluate the need for continued care, and recommend appropriate changs.
- Facillitate discharge planning, and co-ordinate care transitions.
- Develop utilisation review plans, and ensurre compliance with regulatons.
Education
University of Washington School of Medicine, Seattle, Washington
Bachelor of Science in Biomedical Engineering, September, 2020
Skills
Decision Making
Documentation
Conflict Resolution
Organization
Medical Terminology
ICD-10 Coding
CPT Coding
Medical Record Review
Avoid Spelling Mistakes and Include your Contact Information
Missing contact information prevents recruiters from understanding you're the best fit for the position.
Key Insights- Make sure you're not missing contact information on your resume. That should include your full name, telephone number and email address.
- Make sure to use a professional email address as part of your contact information.
- Highlight your contact information and double check that everything is accurate to help recruiters get in touch with you.
utilization review nurse Cover Letter Example
A cover letter can be a valuable addition to your job application when applying for an utilization review nurse position. Cover letters provide a concise summary of your qualifications, skills, and experience, also it also gives you an opportunity to explain why you're the best fit for the job. Crafting a cover letter that showcases your relevant experience and enthusiasm for the Accounts Payable role can significantly improve your chances of securing an interview.
Chief Utilization Review Nurse
NYU Langone Health
New York City, New York
NYU Langone Health
New York City, New York
To the Hiring Team at NYU Langone Health
I am excited to apply for the Chief Utilization Review Nurse position at NYU Langone Health. As a highly skilled Utilization Review Nurse with 7 years of experience in the Medical field, I am confident that I can contribute significantly to your organization.
My life experiences have taught me the importance of hard work, dedication, and collaboration. Whether it was on the work, or just personally, I have always been committed to pursuing my goals with passion and tenacity. I am confident that throughout all of these years I have gained the skills and expertise necessary to succeed in this role and be a great asset for NYU Langone Health. I am eager to join a team that shares my values and work towards a common goal.
I cannot stress enough how thrilled I am about the chance to join a team of like-minded individuals who share my values and passion for this amazing field. Thank you for considering my application and I hope for the chance to work together.
Kind regards,
Todd Turner
792-216-8806
[email protected]
Todd Turner
Showcase your most significant accomplishments and qualifications with this cover
letter.
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Build your Resume in 15 minutes
Give yourself the best chance of standing out from the
competition!
Create an awesome resume that meets the expectations of potential employers with our selection of professional, field-tested resume templates.
Create an awesome resume that meets the expectations of potential employers with our selection of professional, field-tested resume templates.