Utilization Management Nurse Resume

[First Name] [Last Name]

Contact Address: [street] [Country] [City] [State/Province] [Zip Code]

Contact Number: (012)-345-6789

Email Address: [[email protected]]

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Career Objective:

A science graduate in care and nursing management with thorough knowledge and experience of monitoring and assessing patient treatment seeks a challenging role as an utilization management nurse in a reputed hospital.

Summary of Skills:

  • Experience of utilization management, planned discharge and concurrent reviews
  • Thorough knowledge of hospital administration and management, Milliman Care and Medicare guidelines
  • Familiarity with the diagnosis, medical treatment procedures, and insurance claims procedures
  • Ability to take sound decision and exercise wise judgment
  • Well-versed with MS office and all the systems of healthcare, like Med Decision, Clinical Care Advance and EPOCH

Work Experience:

Utilization Management Nurse
Pinnacle Health Services, Southfield, MI
October 2014 – Present

  • Reviewing and documenting patients’ information and the type of medical treatment provided
  • Assessing and ensuring the facility is following medical rules and regulations and providing optimum care to patients
  • Working closely with the medical staff towards improving health and aiding recovery of patients
  • Examining medical reports and identifying gaps in the provided treatment
  • Referring special cases to the medical director and ensuring proper action against negligence in duty
  • Planning and recording each medical interventions done and to be done

Utilization Management Nurse
City Center Hospital, Southfield, MI
February 2013 – September 2014

  • Properly organized, gathered, and entered medical information of patients into the computer system
  • Evaluated and improvised outpatient and inpatient nursing services by taking feedbacks from patients and family members
  • Supported and helped all inpatients in acquiring their insurance benefits and finance
  • Gave excellent healthcare benefits to every patient through utilization management services
  • Monitored, supervised, and performed medical interventions and inpatient service management
  • Implemented effective and positive utilization nursing functions

Education:

  • Bachelor’s Degree in Nursing
    ABC Hospital, Southfield, MI
    2012

Reference:

On request.

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