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Clinical Reviewer/Clinical Appeals Nurse Resume Example

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CLINICAL REVIEWER/CLINICAL APPEALS NURSE
Highlights
  • Trained new nurses and was responsible for training new employees
  • Trained in URAC standards and HIPPA policies
  • Wound cleaning/care expertise

  • Broad medical terminology knowledge
  • Enthusiastic caregiver
  • Body mechanics knowledge
Summary

Self -motivated, efficient, resourceful and reliable. Excellent communication and interpersonal skills. Confident in interactions with individuals at all levels. Resourceful in the completion of tasks with ability to multi-task efficiently. Function effectively as a team player as well as working independently. Possess strong problem solving skills. Excel in fast paced environments.

Experience
Clinical Reviewer/Clinical Appeals Nurse, 04/2010 - 10/2012Care Core National - City , STATE
  • Process clinical certification request for clinical services from physician offices and/or imaging centers
  • Reviews clinical information submitted by providers to appropriate criteria and makes decision to issue a determination or send to physician review
  • Maintains HIPPA and State regulations
  • Serves as a resource for members calling for assistance.
Floor Nurse on a Medical/Telemetry Unit, 05/2009 - 03/2010Cape Fear Valley Medical Center - City , STATE
  • Implement patient care for up to 6 patients per day
  • Admit and discharge patients
  • Assess patients status and notify physician of clinical changes
  • Interact with departments regarding patient care
  • Educate patient/families on health care needs, conditions, options, etc.
  • Maintained patient charts and confidential files
Wound Care and Treatment Nurse, 05/2008 - 04/2009Effingham Extended Care Center - City , STATE
  • Weekly skin assessments on 105 residents
  • Performed wound care using aseptic technique
  • Keeping physicians updated on the status of the wound Educating Nursing Assistants on skin care
  • Attend weekly Medicare/Medicaid meetings.
Education
2013University of Phoenix - City, State, United StatesBachelor of ScienceBusiness/Human Resources
2008Savannah Technical College - City, StateLicensed Practical Nursing License
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How this resume score could be improved?

Many factors go into creating a strong resume. Here are a few tweaks that could improve the score of this resume:

81Good
Resume Strength
  • Completeness
  • Formatting
  • Word choice
  • Measurable results
  • Clear contact info

Resume Overview

School Attended

  • University of Phoenix
  • Savannah Technical College

Job Titles Held:

  • Clinical Reviewer/Clinical Appeals Nurse
  • Floor Nurse on a Medical/Telemetry Unit
  • Wound Care and Treatment Nurse

Degrees

  • Bachelor of Science Business/Human Resources
    Licensed Practical Nursing License

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