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utilization review specialist admissions coordinator resume example with 12 years of experience

Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • Home: (555) 432-1000
  • Cell:
  • resumesample@example.com
Summary

My education and career in social work and human services qualify me for many positions. However, my compassion, my integrity, and my ability to relate and understand children, make me especially qualified for a position in education. Although I was a stay at home mom for many years, (reflected in the gap in work experience on my resume) I still possess the qualities I feel are necessary for maintaining a nurturing, safe, and supportive learning environment for all students.

Skills
  • Extremely patient and compassionate
  • Possess strong work ethic and excellent interpersonal skills
  • Ability to multitask and maintain professional attitude under stressful and/or complicated situations.
  • Priority is to provide a safe, supportive learning environment for students.
Experience
Utilization Review Specialist/Admissions Coordinator, 01/2006 to 09/2009
Family Health Centers Of San Diego, Inc.Spring Valley Elementary School - San Diego, CA,
  • Conducted phone screen interviews with patients and gathered necessary information for admissions and ensured level of care requirements. Verified active insurance coverage and/or set up patients with payment plans for treatment.
  • Collaborated with admissions, clinical and medical staff to gather required medical mental health, and substance abuse information to obtain prior authorization and continued coverage of care through insurance companies.
  • Determined medical necessity and applied level of care guidelines.
  • Contacted and maintained professional relationships with insurance carriers to obtain authorizations for treatment delivered to patients.
  • Kept detailed documentation on all clinical reviews.
  • Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
  • Advocated for patient needs with clinical team to ensure outlined treatment plans are followed, and continued coverage of care is authorized, as well as discharge planning.
Case Manager II, 01/2002 to 01/2006
Atria Senior Living Group, Inc.Gainesville, GA,
  • Interviewed clients and completed intakes using assessment tools, such as LSI and ASUS, to evaluate need for the AIC program, and refer clients to appropriate community and treatment facilities.
  • Provided continued case management services and ensured compliance through group intervention, collecting supervised urine samples, and detailed treatment planning.
  • Linked clients with social services, health care providers and governmental agencies for resources.
  • Encouraged clients to express expectations and goals for their successful rehabilitation.
  • Participated in regular team meetings and in-house training sessions to boost group effectiveness.
  • Submitted emergency financial/medical assistance applications and supporting documentation for eligible clients in need of services.
  • Maintained proper communication with all treatment providers and legal personnel. Acted as a liaison with referral sources (Probation, Parole and Pre-Trial court officials) which included frequent progress reports of clients' compliance and recommendations for continued supervision or discharge from the AIC program.
  • Adhered to ethical principles and standards to protect clients' confidential information.
  • Transitioned clients to different providers based on progress or needs.
School Van Driver/Aide, Autistic Kids, 09/1997 to 08/2002
Ledyard TransportCity, STATE,
  • Provided safe transportation and acted as an aid for special education students to and from school.
  • Performed pre-trip inspection and mechanical checks before scheduled run.
  • Followed schedules and routes to maintain timely arrivals and departures.
  • Obeyed DOT rules and regulations and local laws to maximize safety.
Caregiver, Special Needs, 09/1997 to 05/2002
Private CareCity, STATE,
  • Provided a nurturing, loving, safe environment for a young girl with autism.
  • Assisted her in bathing, dressing, meal prep, personal care needs, as well as homework and transportation to and from school.
  • Encouraged her to participate in social and activities of daily living to enhance personal dignity.
  • Maintained clean and well-organized environment to ensure her happiness and safety.
  • Improved her outlook and daily living through compassionate care.
  • Observed her for changes in physical, emotional, mental or behavioral condition.
  • Maintained contact with her educators to keep consistency with her school and home expectations, and communicate any issues that may affect her day/evening.
Education and Training
Bachelor of Arts: Sociology, Expected in 05/2002
Eastern Connecticut State University - Willimantic, CT
GPA:
  • Overall GPA 3.6 (Cum Laude)
  • Dean's List (Six semesters)
  • Academic Achievement Award for Sociology (Selected by professors for an all around student with highest GPA. I worked three jobs and took classes on nights and weekends, while maintaining excellent attendance, participation, and grades.)
: General Education Requirements , Expected in
University of Connecticut - Storrs, CT
GPA:
  • I completed one year on campus and decided to transfer to a smaller school and commute, to reduce my student loan costs.

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Resume Overview

School Attended

  • Eastern Connecticut State University
  • University of Connecticut

Job Titles Held:

  • Utilization Review Specialist/Admissions Coordinator
  • Case Manager II
  • School Van Driver/Aide, Autistic Kids
  • Caregiver, Special Needs

Degrees

  • Bachelor of Arts

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