Utilization Review Nurse Resume

The services that utilization review nurses provide to insurance companies, medical facilities, and patients help in keeping the healthcare industry free of any problems. With an insurance company, they can review medical claims and find out if they should be honored or dishonored. With a hospital, they will help both patient and the facility with their analysis skills and determine whether the patient needs to be hospitalized or can be provided care at the outpatient department. This does not keep a bed occupied and can be used for someone who actually need to be admitted. In short, wherever they work, they review the situations and take fair decision in the interest of involved parties.

This is sample resume through which the candidate is displaying her skills and experience of working with a hospital as an utilization review nurse.

Utilization Review Nurse Resume Example

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Julie A. Green
4077 Lawman Avenue
Falls Church, VA 22042
Phone: 703-206-5076
Email: jagreen@example.com

Career Objective:

I am looking for an utilization review nurse position with “Max T. Medical Center” to review patient cases and save time and money for both the patient and the management.

Summary of Skills:

• Strong knowledge of medical terminology and admission assessment experience
• Knowledge of rules and regulations of Medicare and private insurance companies
• Excellent ability to review patient cases and take decision
• Strong aptitude for patient-centric nursing care
• Strong interest and experience in teaching and guiding patients
• Skilled in initiating quality improvement programs

Work Experience:

Utilization Review Nurse
Humble Care, Inc., Falls Church, VA
December 2012 - Present

• Review patient cases and answer efficiently all inquiries regarding admission
• Ask for any insurance coverage the patient is holding and check what it covers
• Inform patients about medical items not included in the insurance policy
• Determine if patient needs to be admitted or can be treatment at outpatient department
• Stay update about the available beds in the facility and patients scheduled for discharge
• Review medical cases and suggest certain medications and medical imaging
• Ensure patient care is provided according to the medical necessity of patients
• Check if the provided medical care meets the insurance company standards

Utilization Review Nurse
Lovely Medical Center, Falls Church, VA
July 2010 - November 2012

• Reviewed admission cases and ensure appropriate patient placement
• Monitored patients for 24 hours and determined and performed stay review
• Promoted and restored patients mental health and physical status through quality care
• Informed patients and families about change in health status
• Assessed provided care and suggest physicians to modify given therapy
• Worked closely with the interdisciplinary team and stayed current of patient status
• Provided training to new and existing staff and monitored their performances
• Assisted patient in claim settlement by providing accurate clinical assessment to insurance companies

Education:

• Bachelor's Degree in Nursing
  ABC Nursing School, Falls Church, VA
  2009

Reference:

On request.