utilization management specialist resume example with 14 years of experience
JessicaClaire
Montgomery Street, San Francisco, CA94105609 Johnson Ave., 49204, Tulsa, OK
Home: (555) 432-1000
Cell:
resumesample@example.com
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Summary
Three years of experience in utilization management at UAB hospital. Maintain strong reputation for achieving high levels of appropriate patient reviews under Interqual criteria. Previously provided six years of excellent nursing care in various clinical/bedside nursing roles. Seeking leadership role with a rural health system committed to delivering effective healthcare that meets the social and cultural needs of the rural communities that it serves.
Skills
Committed to compliance reporting
Culturally sensitive
Familiarity with disease management programs
Computerized charting specialist
Strong medical ethic
Staffing management ability
Conflict resolution
Confident public speaker
Personal and professional integrity
Relationship and team building
Education and Training
Master of Science: Nursing and Health Systems Administration, Expected in present to University of Alabama at Birmingham, School of Nursing - Birmingham, AL GPA:
4.0 GPA
Member of Nursing Graduate Student Association
Associate of Applied Science: Nursing, Expected in 2008 to Three Rivers Community College - Poplar Bluff, MO GPA:
Dean's List
Member of Student Nurses Association
BBA: Management, Expected in 1996 to Baylor University - Waco, TX GPA:
Member of Society for Human Resource Managers
Member of Kappa Chi Alpha sorority
Experience
Utilization Management Specialist, 06/2014 to Current Adventist Health System – Fl -, FL,
Review each patient for appropriate Level of Care utilizing Interqual verification; verify that documentation and orders entered by providers are appropriate and accurate; perform concurrent stay reviews to determine medical necessity for continued length of stay in order to remain in compliance with CMS regulations.
Perform quality checks in order to adequately prepare for RAC/MAC audits.
Interact with the Medical, Nursing, and Ancillary department staff to facilitate quality based, cost effective patient outcomes.
Work with the Medical Staff to ensure that patient care is provided in the most appropriate setting as well as the multidisciplinary team to ensure wise utilization of resources.
Clinic Nurse, 2013 to 05/2014 Archcare – Garrison, NY,
Complete management of all patient health concerns and collaborating with the doctors on the appropriate course of action to adequately provide the proper care for each patient.
Primary disease management for Parkinson's disease, Dystonia, Essential tremor, and multiple other movement disorders.
RN Health screener, 05/2012 to 10/2012 Department Of Veterans Affairs – Minneapolis, MN,
PRN Independent Contract RN for local health fairs.
Clinical Care Coordinator/Charge Nurse, 11/2011 to 04/2012 BAPTIST MEDICAL CENTER – City, STATE,
Supervised the continuity of complete patient care from admission to discharge, and coordinated staffing within the unit.
PRN Med/Surg Staff RN, 10/2011 to 01/2012 RUSH FOUNDATION HOSPITAL – City, STATE,
Complete patient care for both critical and non-critical individuals with multiple co-morbidities
Critical Care/Med-Surg Travel RN, 03/2011 to 10/2011 JACKSON NURSE PROFESSIONALS – City, STATE,
Administration of appropriate care with regard to the personal and medical needs of the individual patient and the needs of the facility.
RN Health Screener, 01/2011 to 11/2012 FAVORITE HEALTHCARE STAFFING, INC – City, STATE,
Provided on-site health screenings for various industrial companies
RN Health Screener, 01/2011 to 11/2012 CIGNA ONSITE HEALTH SCREENING – City, STATE,
Provided on-site health screenings for companies that utilized Cigna insurance for their employees
Staff RN, 02/2010 to 2011 LANDMARK HOSPITAL – City, STATE,
Acute Care Staff RN for this 28 bed LTAC facility.
Complete patient care for both critical and non-critical individuals with multiple co-morbidities.
Staff RN/Assistant Charge RN, 06/2008 to 05/2010 SOUTHEAST MISSOURI HOSPITAL – City, STATE,
Complete patient care for non-critical individuals with multiple co-morbidities.
Student Nurse & PRN Nursing Assistant, 01/2007 to 05/2008 POPLAR BLUFF REGIONAL MEDICAL CENTER – City, STATE,
Float pool.
Complete non-skilled nursing care for critical and non-critical individuals with multiple co-morbidities.
Activities and Honors
Sigma Theta Tau Honor Society of Nursing; Dec. 2016 - Present
Cambridge Who's Who of Executives, Professionals, and Entrepreneurs; May 2011
Medical Reserve Corps of Alabama; Current
Alabama Emergency Response Volunteer; Current
Fosters/Ralph Volunteer Fire Department Firefighter and First
Responder: Fosters/Ralph Fire District, Alabama; Feb. 2011 - Dec. 2013
Show-Me Response Volunteer: Missouri; 2009-2011
First Aid Provider for SEMO Hospital sponsored events; Cape Girardeau, Missouri; 2008-2010
Skills
BLS certified; expires 01/2019
Acute Care, CMS, disease management, documentation, RAC/MAC, Nursing, patient care, quality, staffing, Interqual, Excel, Word, PowerPoint
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Resume Overview
School Attended
University of Alabama at Birmingham, School of Nursing