SEARCH

Utilization Review Nurse Resume Example

Resume Score: 80%

Love this resume?Build Your Own Now
UTILIZATION REVIEW NURSE
Professional Summary

Knowledgeable Program Director well-versed in providing strategic direction and ongoing leadership in staff development projects. Veteran of nursing with 15-year demonstrated track record of success. Ready to apply expertise and experience to challenging new role at Galen College of Nursing.

Skills
  • Process improvement
  • Relationship development
  • Problem resolution
  • Preventative health
  • Strong clinical judgment
  • Improvement planning
  • Business Development and Planning
  • Staff Management
  • Product presentation
  • Product promotions
  • 10 + years of wound care experience (highly proficient)
  • Customer service
  • Quality controls
  • Microsoft applications proficiency
  • Chronic disease management
  • Acute care expertise
  • Goals and Performance
  • Trend Analysis
  • Systems and software programs
  • Needs assessment
  • Sales (5+ years)
Work History
Utilization Review Nurse, 03/2020 to Current
Cognizant Technology Solutions – Tampa, FL
  • Leveraged feedback and process improvement opportunities to create safer and healthier environment and increase patient satisfaction
  • Evaluated medical guidelines and benefit coverage to determine appropriateness of services
  • Performed prior authorization review of services requiring notification.
  • Devise or identify solutions for irregular requests and issues.
  • Obtained authorizations from multiple insurance carriers for various levels of care.
  • Participated in education activities, including evidence-based practice project implementation, nursing competency development and nursing simulation activities.
Nurse Practice Educator, 08/2019 to 03/2020
Sunset Point – Clearwater, FL
  • Supported student educational and vocational planning to help each optimize learning strategies and reap long-term career benefits.
  • Strived to continuously update course strategies and content based on current trends and technological advancements in healthcare.
  • Contributed educational and clinical expertise to help optimize training courses and boost student learning.
  • Assessed student knowledge levels and abilities with detailed assessments.
  • Directly cared for patients at least 40 hours each month to maintain currency on clinical techniques.
  • Liaised with clients to identify and target inefficiencies in areas of risks and business controls, process gaps and workflow discrepancies.
  • Delivered subject matter expertise for internal and external customers on compliance best practices and quality control.
  • Prepared and presented comprehensive reports to upper management and audit team, covering issues and recommendations.
  • Delivered and tracked program training for all associates and supervisors in order to safeguard continuing business relationships.
  • Conducted routine facility inspections, identifying areas needing improvement and eliminating hazards posed to staff and residents for continued compliance with associated regulations.
Assistant Director of Nursing, 11/2018 to 06/2019
Tarpon Bayou Center – Tarpon Springs, FL
  • Established and monitored infection control programs to provide safe, sanitary environment to prevent transmission of disease and infection.
  • Prepared and reviewed infection control surveillance reports to identify trends and develop effective actions to control and prevent infections.
  • Evaluated work performance of 80+ nursing personnel to determine wage increases and implement discipline.
  • Developed positive employee relations, incentives and recognition programs to promote teamwork and mutual respect.
  • Participated in morning and stand down management team meetings to discuss resident status, census changes and resident complaints or concerns.
  • Collaborated with staff, management and external groups to coordinate patient care.
  • Performed rounds to observe care and interview staff, residents and families.
  • Generated and reviewed incident reports, including employee write-ups, actualizing appropriate corrective action plans to mitigate ongoing and potential situations.
  • Monitored and inspected staff processes to eliminate hazards posed for both residents and staff while ensuring continuous compliance with regulations.
  • Conducted routine facility inspections, identifying areas needing improvement and eliminating hazards posed to staff and residents for continued compliance with associated regulations.
Nurse Consultant, 03/2016 to 10/2018
MetLife – Tampa, FL
  • Reported policy changes and company conditions affecting customer satisfaction.
  • Modeled exceptional customer service skills and appropriate diagnostic sales techniques to team members.
  • Followed up with customers on unresolved issues.
  • Reviewed new files to determine current status of injury claim and to develop plan of action.
  • Delivered exceptional customer service to policyholders by communicating important information and patiently listening to all issues.
  • Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
  • Teamed up with managers and executives to assist in evaluating and improving performance of direct services, contributing to strategic program planning and development.
  • Communicated with supervisor regarding issues related to case management, resourcing, service collaboration and development of new resources.
  • Made appropriate referrals, monitored client services in appropriate time frames, sought supervisory guidance as required, documented services provided and completed departmental billing procedures.
Education
Bachelor of Science: Student Nursing, Expected in 06/2021
Saint Petersburg College - Saint Petersburg FL
  • Coursework in progress for RN to BSN
Associate of Science: Nursing, 12/2012
Hillsborough Community College - Plant City, FL
Associate of Science: Nursing, 12/2008
Erwin Technical College - Tampa, FL
  • Received Licensed Practical Nursing Certification
Bachelor of Science: Interdisciplinary Studies, 05/2006
University of South Florida - Tampa, FL
  • Minored in Bio-Medical Sciences
Certifications
  • First Aid/CPR Certified
  • Advanced Cardiac Life Support Certified
  • Registered Nurse
  • Infection Preventionist
  • IV/PICC Line Certified
Build Your Own Now

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.

Resume Overview

Companies Worked For:

  • Cognizant Technology Solutions
  • Sunset Point
  • Tarpon Bayou Center
  • MetLife

School Attended

  • Saint Petersburg College
  • Hillsborough Community College
  • Erwin Technical College
  • University of South Florida

Job Titles Held:

  • Utilization Review Nurse
  • Nurse Practice Educator
  • Assistant Director of Nursing
  • Nurse Consultant

Degrees

  • Bachelor of Science : Student Nursing , Expected in 06/2021
    Associate of Science : Nursing , 12/2012
    Associate of Science : Nursing , 12/2008
    Bachelor of Science : Interdisciplinary Studies , 05/2006

Similar Resumes

View All
Utilization-Review-Nurse-resume-sample

Utilization Review Nurse

Dallas, Texas