LiveCareer-Resume

utilization review nurse resume example with 4+ years of experience

Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • H: (555) 432-1000
  • C:
  • resumesample@example.com
  • Date of Birth:
  • India:
  • :
  • single:
  • :
Summary

Skilled Utilization Review Nurse offering talents in continuous assessments and clinical records oversight. Pleasant individual with over 6 years in the nursing field. Ready to join new company that appreciates attention to detail and exemplary clinical review skills.

Skills
  • Utilization Review Nursing
  • Medical Surgical Nursing
  • Critical Care Nurse
  • Microsoft Office
Experience
Utilization Review Nurse, 12/2022 - Current
Seattle Children's Hospital Federal Way, WA,
  • Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
  • Submitted cases for criteria failures and helped facilitate resolutions and approvals.
  • Obtained authorizations from multiple insurance carriers for various levels of care.
  • Performed admission reviews based for medical necessity based upon specification.
  • Explained course of care and medication side effects to patients and caregivers in easy-to-understand terms.
Utilization Review Nurse, 10/2021 - 11/2022
Seattle Children's Hospital Bothell, WA,

Job Title: Registered Nurse Case Utilization Review Nurse

Job responsibilities: pre-certified inpatient and observation hospital stays for patients admitted to our facilities, faxed clinical to payers, performed initial, concurrent and retro reviews on cases, discussed cases with the attending physician to request upgrade to inpatient level of care if the case met medical necessity criteria based on Interqual Care Guidelines or a downgrade to observation level of care if the case did not meet inpatient level of care criteria based on review of the Interqual Care Guidelines, discussed denied cases with the attending physician, scheduled peer to peers discussion for the attending physician, entered case approval authorizations and denials into the computer, made case outreach calls to providers to resolve case issues and received inbound calls from providers to resolve any case issues. Submitted eligible cases to R1 Physician Advisory Group to complete peer to peer discussions for our physicians.

Utilization Review Nurse, 01/2020 - 02/2021
Seattle Children's Hospital Anchorage, AK,

Job Title: Registered Nurse Case Coordinator/Utilization Review Nurse

Job responsibilities: pre-certified inpatient and observation hospital stays for patients admitted to our facilities, faxed clinical to payers, performed initial, concurrent and retro reviews on cases, discussed cases with the attending physician to request upgrade to inpatient level of care if the case met medical necessity criteria based on Milliman Care Guidelines or a downgrade to observation level of care if the case did not meet inpatient level of care criteria based on review of the Milliman Care Guidelines, discussed denied cases with the attending physician, scheduled peer to peers discussion for the attending physician, entered case approval authorizations and denials into the computer, made case outreach calls to providers to resolve case issues and received inbound calls from providers to resolve any case issues.1/2020-2/2021

Prior Critical Care Nurse, 11/2017 - 01/2020
Doctors Community Hospital City, STATE,

Job Title: Critical Care Registered Nurse

11/2017-1/2020

Job responsibilities: • Monitor exact, detailed reports and records of critical ICU patient.

• Monitor and record symptoms and changes in patients’ conditions and inform to physician.

• Order, interpret and evaluate diagnostics tests to identify and assess patient’s condition.

• Carefully observe and document patient medical information’s and vital signs.

• Document patients’ medical histories and assessment findings.

• Document patients’ treatment plans, interventions, outcomes, or plan revisions.

• Consult and coordinate with health care team members about whole patient care plans.

• Modify patient treatment plans as indicated by patient’s response and conditions.

• Monitor the critical patients for changes in status and indications of conditions such as sepsis or shock and institute appropriate interventions.

• Administering intravenous fluids and medications as per doctor order.

• Monitor patients’ fluid intake and output to detect emerging problems such as fluid and electrolyte imbalances.

• Monitor all aspects of patient care, including diet and physical activity.

• Identify patients who are at risk of complications due to nutritional status.

• Direct and supervise less skilled nursing/health care personnel or supervise a particular unit on one shift to patient’s response and conditions.

• Treating wounds and providing advanced life support.

• Assist physicians with procedures such as bronchoscopy, endoscopy, endotracheal intubation, and elective cardioversion.

Ensuring that ventilator, monitors and other types of medical

Education and Training
Associate of Science: Registered Nursing Nursing, Expected in 05/2017
-
Chamberlain University - Downers Grove, IL
GPA:
Status -
Associate of Science: Registered Nurse, Expected in 05/2017
-
Howard Community College - Columbia, MD
GPA:
Status -

By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy

Your data is safe with us

Any information uploaded, such as a resume, or input by the user is owned solely by the user, not LiveCareer. For further information, please visit our Terms of Use.

Resume Overview

School Attended

  • Chamberlain University
  • Howard Community College

Job Titles Held:

  • Utilization Review Nurse
  • Utilization Review Nurse
  • Utilization Review Nurse
  • Prior Critical Care Nurse

Degrees

  • Associate of Science
  • Associate of Science

By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy

*As seen in:As seen in: