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Prior Authorization Nurse Resume Example

Resume Score: 70%

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PRIOR AUTHORIZATION NURSE
Professional Summary

Served twelve years in United States Army and Airforce in the capacity of an Aeromedical Technician. Fully credentialed LPN and CCM with over 16 years of case management experience in the areas of FMLA, Workers Compensation, STD and LTD and Medicare/Medicaid. Direct experience with medical surgical, rehabilitation, transitional care, respiratory care, geriatric care and home health care.

Licenses

State Licensed LPN, Certified CCM, Certified NREMT and Combat Medic

Skill Highlights
  • Extensive medical terminology knowledge
  • Effective policy and program development
  • Culturally sensitive
  • Strong medical ethics
  • Medical/clinical procedures comprehension
  • Field case management
  • Body mechanics knowledge
  • Comprehensive telephonic case management
  • STD/LTD mastery
  • FMLA expertise
  • Medicare/Medicaid administration
  • Job accommodation analysis

Professional Experience
Prior Authorization Nurse
April 2013 to Current
Medica - Minnetonka, MN
  • Prior authorization of surgical intervention
  • Authorization of genetic testing
  • Authorization of durable medical equipment
  • Adherence to policy and guidelines as indicated by commercial insurance carries and Medicare/Medicaid
Clinical Specialist
December 2012 to April 2013
Univita - Eden Prairie, MN
  • Verification of Medicare/Medicaid coverage
  • Authorization of requested disciplines for home health care services
  • Detailed communication with medical providers and home health care providers
  • Assimilation and dissemination of necessary medical information
Telephonic Case Management
November 2009 to December 2012
Sedgwick CMS - Eden Prairie, MN
  • STD and FMLA claims case management
  • Review medical information to determine functional impairment
  • Authorization or denial of STD and LTD claims
  • Determine job necessities based upon recommendation
Case Manager
August 2005 to November 2009
Encore Unlimited - Eden Prairie, MN
  • Field and telephonic case management of workers compensation
  • Ergonomic work site analysis
  • Implemented return to work accommodations
Worker Compensation Review Manager
April 1998 to August 2005
Health Partners Inc. - St. Paul, MN
  • Designed the Worker Compensation Bill Review Department
  • Developed and implemented process for that department
  • Oversight of training, hiring and coaching staff
  • Instituted cost reduction strategies for department
Education and Training
Associate of Science : Nursing, 1982Wisconsin Indianhead Community College - Superior, WI, USA
Bachelor of Science : NursingRegents College - Albany, NY, USA
  • Currently enrolled
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Resume Overview

Companies Worked For:

  • Medica
  • Univita
  • Sedgwick CMS
  • Encore Unlimited
  • Health Partners Inc.

School Attended

  • Wisconsin Indianhead Community College
  • Regents College

Job Titles Held:

  • Prior Authorization Nurse
  • Clinical Specialist
  • Telephonic Case Management
  • Case Manager
  • Worker Compensation Review Manager

Degrees

  • Associate of Science : Nursing , 1982
    Bachelor of Science : Nursing

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