utilization review nurse resume example with 20+ years of experience

Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • Home: (555) 432-1000
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Experienced nursing professional bringing demonstrated clinical expertise, leadership skills, technical knowledge, and excellent patient care. Offering efficient time management, great customer service, and critical thinking utilizing over 12 years of experience in behavioral health. Highly organized, proactive and punctual with team-oriented mentality. Proficient in updating charts, monitoring medications and working with multidisciplinary teams to optimize patient care. Quality-driven and efficient with strong interpersonal abilities. Flexible hard worker ready to learn and move on to new challenges while overall contributing to team success.

  • Utilization review experience
  • Continuous assessments
  • Unit administration
  • Staff Development and Precepting
  • Working collaboratively
  • Customer service
  • Organizational skills
  • Skilled in the use of technology
  • Critical thinking
  • Team management
Utilization Review Nurse, 02/2014 to Current
Holy Redeemer Health SystemHuntingdon Valley, PA,
  • Collaborated with Psychiatrists, Therapists and Nurses in group meetings to identify issues and address patient plans of care to provide best possible individualized care.
  • Kept detailed documentation on all utilization reviews by using Midas systems.
  • Contacted insurance carriers to obtain authorizations for services delivered to patients.
  • Reviewed patient admissions to determine medical necessity as directed by Interqual and Milliman Care Guidelines criteria.
  • Managed physician peer review and post-service appeal processes pertaining to denials and potential denials as outlined by insurance carriers.
  • Assessed patient conditions, monitored behaviors and updated supervising physicians with observations and concerns.
  • Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
  • Advocated for patient needs with interdisciplinary team and implemented outlined treatment plans.
Clinical Nurse Manager, 09/2011 to 02/2014
Plymouth Harbor On Sarasota BaySarasota, FL,
  • Provided strong leadership and guidance to nurses.
  • Mentored and coached nursing staff, listening to concerns and providing counsel.
  • Evaluated performance of staff nurses, contributing to professional development.
  • Supervised daily nursing activities and general operations while delivering exceptional care and building solid nursing teams for Psychiatric facility with more than 80 beds.
  • Supervised hiring, training and development of nursing and Behavioral Health staff.
  • Maintained quality care systems, standards and HIPAA confidentiality.
  • Handled probationary and annual performance evaluations for nursing staff.
  • Managed over 20 nursing staff and 40 assistants caring for pediatric and adolescent mental health and substance abuse patients.
  • Conferred with physicians during rounds, advised each on condition of patients and coordinated necessary diagnostic assessments to accomplish patient care goals.
  • Identified physical, emotional and social needs of patients during daily planning and addressed critical issues immediately.
  • Engaged in quality control, reviewing charts for accuracy on weekly basis.
Registered Nurse /RN Supervisor /Charge Nurse, 09/2009 to 09/2011
Tenneco AutomotiveAngola, IN,
  • Advised, coached and mentored experienced and student nurses on medical issues, crisis management and appropriate nursing interventions.
  • Updated physicians on patient test results and assisted in developing care plans.
  • Monitored and recorded patient condition, vital signs, recovery progress and medication side effects.
  • Administered medications, tracked dosages and documented patient conditions.
  • Trained new RN hires and ancillary staff members to meet patient service goals, champion standards of care and improve patient overall satisfaction.
  • Oversaw patient admission and discharge processes to coordinate related paperwork.
  • Prioritized nursing tasks and assignments and accurately reported patient status.
  • Maintained personal and team compliance with medication administration standards and patient care best practices.
  • Acted as patient advocate and implemented total patient care through team nursing process.
  • Observed and interpreted patients' symptoms, devised individualized care plans, delivered best and most suitable care and advice and communicated to nursing staff, therapists and physicians.
Manufacturing Engineer, 12/1997 to 12/2006
Owens Illinois, O-ICity, STATE,
  • Maintained current knowledge base of manufacturing industry best practices for lean manufacturing, demand flow technology, and statistical process control.
  • Resolved in-house production inefficiencies, establishing qualifications and procedures for part manufacturing including process routing, fixture design, and machining CNC programs.
  • Troubleshoot and repaired designs, materials and processes of part production for glass bottle production equipment.
  • Devised, evaluated, implemented and oversaw multiple manufacturing projects of large scope from planning to completion.
  • Contributed to product design and prototype development.
  • Provided Quality Control of finished machinery at global customer facilities in regard to alignment of glass delivery system by holding to tolerances of within 0.010" along all three axes.
Education and Training
Associate of Applied Science: CAD Technology, Expected in 07/2005 to Lewis And Clark Community College - Godfrey, IL,
Associate of Applied Science: Nursing, Expected in 05/2009 to Lewis And Clark Community College - Godfrey, IL,
  • Awarded Nursing Leadership Award while attending schooling for Registered Nursing.
  • Recognized as Employee of the Quarter for outstanding performance and team contributions.
  • Promoted from Registered Nurse to Registered Nurse Supervisor/Charge Nurse, in less than 12-months and then on to Clinical Nurse Manager in slightly more than 12-months time.
  • Consistently maintained high customer satisfaction ratings.
  • Successfully able to transition from one successful career to another.

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Resume Overview

School Attended

  • Lewis And Clark Community College
  • Lewis And Clark Community College

Job Titles Held:

  • Utilization Review Nurse
  • Clinical Nurse Manager
  • Registered Nurse /RN Supervisor /Charge Nurse
  • Manufacturing Engineer


  • Associate of Applied Science
  • Associate of Applied Science

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