registered nurse utilization management resume example with 20+ years of experience
Jessica
Claire
resumesample@example.com
(555) 432-1000,
, , 100 Montgomery St. 10th Floor
:
Summary
Skilled Utilization Review Nurse offering talents in continuous assessments and clinical records oversight. Pleasant individual with over 29 years in the nursing field. Ready to join new company that appreciates attention to detail and exemplary clinical review skills. Self-motivated professional promoting attention to detail and the drive to resolve issues effectively. Calm and poised in the most stressful environments. Seeking the opportunity to join new organization in order to broaden my scope and knowledge. Energetic individual offering 15 years' experience in reviewing compliance standards and auditing charts. Astute Utilization Review Nurse knowledgeable in medical data gathering, analysis and authorization obtainment. Self-motivated professional promoting attention to detail and the drive to resolve issues effectively. Calm and poised in the most stressful environments. Also competent in the IP side of the denials process - both pre-billing and post- billing. Energetic individual offering 15 years' experience in reviewing compliance standards and auditing charts. Astute Utilization Review Nurse knowledgeable in medical data gathering, analysis and authorization obtainment. Skilled Utilization Review Nurse offering talents in continuous assessments and clinical records oversight. Pleasant individual with over 29 years in the nursing field. Ready to join new company that appreciates attention to detail and exemplary clinical review skills.
Skills
Performing Assessments
Needs Assessment
Interpersonal and Written Communication
Records Analysis
Communication
Documentation and Reporting
Patient Transfers and Transitions
Utilization Review
Crisis Prevention Intervention (CPI)
Medicare Compliance
Risk Mitigation
Codes Compliance
Resource Monitoring
Records Maintenance
Resource Allocation
Denials Management - working pre- billing and post billing denial process when needed.
Education and Training
Southeastern Community CollegeWhiteville, NCExpected in 05/1993 ā āAssociate of Applied Science:Registered Nursing - GPA:
First to graduate from Southeastern Nursing Program with a GPA of 4.0.
Determined medical necessity and cost-effectiveness of services through utilization review processes.
Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries.
Applied medical criteria and clinical judgement to researched cases to evaluate and establish determinations.
Remained up-to-date on various benefit plans, medical policies and state-specific clinical guidelines or criteria.
Reviewed patient admissions to determine medical necessity as directed by MGC and InterQual criteria.
Reviewed patient admissions to determine medical necessity as directed by MCG or InterQual criteria.
Referred cases to secondary review for failure to meet MCG or InterQual criteria.
Reviewed patient admissions to determine medical necessity as directed by specific criteria based on payor source.
Scripps Health - Registered Nurse Case Manager San Marcos, CA, 03/2008 - 03/2010
Developed patient care plans, overall patient health assessments and evaluations.
Actively participated in family and patient planning processes.
Determined and coordinated appropriate level of care to meet individual patient needs.
Updated and maintained discharge plan of care with physician, members of healthcare team, patients and families.
Collaborated with physicians on patient medications, medical needs and performance.
Incorporated appropriate nursing methods to create individualized care plans.
Assessed and reviewed patients for discharge and planning and integrated services for patients requiring home care, home infusion and durable medical equipment (DME).
Collaborated in consults, patient care plans development, patient monitoring and evaluations.
Performed all components of the Utilization Review process for assigned patients as well.
Ardent Health Services - Registered Nurse, Float Pool Owasso, OK, 11/1993 - 03/2008
Assessed patient needs, prioritized treatment, maintained patient flows and assisted physicians with non-invasive procedures.
Administered medications and treatments, monitoring patients for reactions and side effects.
Adhered to infection control procedures to facilitate safe, clean patient environment.
Evaluated patients, recognized and addressed complications and coordinated treatment with other members of critical care team.
Maintained thorough, accurate and confidential documentation in electronic medical records.
Acted as patient advocate and implemented total patient care through team nursing process.
Recorded patient condition, vital signs, recovery progress and medication side effects.
Monitored and managed various treatment and care interventions.
Advocated for patients by supporting and respecting basic rights, values and beliefs.
Administered medications, tracked dosages and documented patient conditions.
Updated charts throughout shifts with current, accurate information to maintain strict recordkeeping standards.
Provided patient and family health education focusing on self-management, prevention and wellness.
Assessed and prepared patients for procedures, performing initial and ongoing patient assessments.
Collected lab specimens, ordering and interpreting diagnostic tests and lab results.
Maintained personal and team compliance with medication administration standards and patient care best practices.
Oversaw patient admission and discharge processes to coordinate related paperwork.
Created, implemented and evaluated patient care plans with medical team.
Counseled patients and caregivers, providing emotional, psychological and spiritual support.
Collaborated with doctors to plan post-treatment home care and prevent return hospitalization.
Conducted intake assessments with patients and relatives to gather case history.
Monitored patients after surgery, answered questions and provided home care strategies.
Bladen County Hospital - Registered Nurse, Emergency Department City, STATE, 05/1993 - 11/1993
Assessed patient needs, prioritized treatment, maintained patient flows and assisted physicians with non-invasive procedures.
Administered medications and treatments, monitoring patients for reactions and side effects.
Adhered to infection control procedures to facilitate safe, clean patient environment.
Evaluated patients, recognized and addressed complications and coordinated treatment with other members of critical care team.
Maintained thorough, accurate and confidential documentation in electronic medical records.
Acted as patient advocate and implemented total patient care through team nursing process.
Recorded patient condition, vital signs, recovery progress and medication side effects.
Monitored and managed various treatment and care interventions.
Advocated for patients by supporting and respecting basic rights, values and beliefs.
Administered medications, tracked dosages and documented patient conditions.
Updated charts throughout shifts with current, accurate information to maintain strict recordkeeping standards.
Provided patient and family health education focusing on self-management, prevention and wellness.
Assessed and prepared patients for procedures, performing initial and ongoing patient assessments.
Collected lab specimens, ordering and interpreting diagnostic tests and lab results.
Maintained personal and team compliance with medication administration standards and patient care best practices.
Counseled patients and caregivers, providing emotional, psychological and spiritual support.
Helped nursing staff provide quality, competent patient care for diverse emergencies.
Tracked patients' vital signs, treated wounds and collected samples to free up nurses and physicians for more advanced work.
Worked alongside doctors and nurses to provide supplies, instruments and equipment for procedures.
Assisted with fitting patients for casts, crutches and other medical devices.
Monitored patients for signs of distress or decompensation and alerted staff of emergency situations.
Prioritized care based on clinician orders and current patient symptoms to optimize resource utilization.
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