Concurrent Review Nurse Resume Example
Fifteen years of clinical experience in primary care including Medical Surgical and Neonatal ICU. Over 11 years of experience in Utilization Review, Discharge Planning working directly with Interqual/ Milliman and DRGS. Familiarity with ICD and CPT coding. Experience with HEDIS reviews, Medicaid and Medicare. Worked remotely for the past 10 years and have excellent autonomous analytical and decision making skills.
RN license in the state of Delaware and Pennsylvania.
McKesson Certified in 2001.
|
|
Grandville , MI
Perform daily utilization review and discharge planning for medicaid members in acute and sub acute settings. Present cases to the medical team including medical directors and case managers to coordinate timely and appropriate care. Developed a team approach regarding daily reviews which was adopted by the Utilization Management team.
Fort Pierce , FL
Conduct utilization management review remotely on a daily basis applying Interqual criteria. Interact with medical directors, case managers and the behavior health to ensure successful outcomes for the patient. Developed new systems and policies to aid in streamlining work processes.
Bangor , ME
I worked temporary positions in the insurance industry conducting HEDIS reviews for Aetna and provided utilization management for Keystone Mercy and BCBSDE using Interqual and Milliman criteria for per diem and DRG facilities.
City , STATE
Provided for neonates in a clinical setting. During time at Christiana I also obtained a weekend Utilization Review position and became McKesson certified. The position enabled me to transition out of the clinical setting to the Utilization Management area.
City , STATE
City , STATE
DISCLAIMER
Resumes, and other information uploaded or provided by the user, are considered User Content governed by our Terms & Conditions. As such, it is not owned by us, and it is the user who retains ownership over such content.
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:
- Completeness
- Formatting
- Word choice
- Measurable results
- Strong summary
- Clear contact info
- Typos
Resume Overview
School Attended
- Delaware County Community College
Job Titles Held:
- Concurrent Review Nurse
- Utilization Management R.N.
- Utilization Management/HEDIS nurse
- Neonatal Intensive Care Nurse
- Visiting Nurse/Home Healthcare
- Medical Surgical RN
Degrees
- ASN : Nursing
Similar Resumes
