Utilization Manager Resume
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706 Aviation Way
Pomona, CA 91766
(111)-807-2864
m.robinson@emailaddress.com
Job Objective: Seeking a position with company in which to exercise my experience and training as a Utilization Manager.
Highlights of Qualifications:
Huge experience in managing health care , managing clinical documents and developing and implementing various programs
Exceptional knowledge of methods and various techniques of health care
Huge knowledge of health plans and related processes
Outstanding ability to provide optimal service in multiple health care facility
Ability to work in coordination with medical staff
Skilled to work on computer and resolve problems
Remarkable oral and written communication skills
Proficient n understanding all components of health care
Familiarity in medical terminology and related contracts
Professional Experience:
Utilization Manager
Amerigroup, Pomona, CA
October 2008 - Present
Reviewed acute service at site and on telephone as well.
Planned pre admission of patients required and prepared post discharge care.
Managed work in accordance to guidelines provided to validate medical work.
Coordinated with manager and prepared census for various health care services.
Maintained quality services with maximum utilization of available resources.
Documented all policies in system according to time.
Monitored Quality Improvement Process carried by members.
Provided customer service to both internal and external customers.
Utilization Coordinator
AppleOne, Pomona, CA
August 2003 - September 2008
Reviewed all patient information and recorded details of patient illness and resources utilized for services.
Coordinated with physician and discharge staff and facilitated patient care and timely discharge.
Managed vendors and provided external parties necessary information of facility to obtain necessary certificates.
Assisted coding staff in documenting process such as patient condition, resource used and any medical emergency rendered.
Evaluated all medical records and performed quality monitoring on required documents.
Planned and assessed al patient discharge.
Utilization Lead
CVS Caremark, Pomona, CA
May 1998 - July 2003
Reviewed all contracts and ensured benefit eligibility and authorized inpatient admission.
Monitored cases and referred cases for clinical review and handled specialty care services.
Coordinated between internal departments and medical management.
Managed all queries by clients and assisted various in house departments.
Trained new employees and subordinate staff in various functions.
Evaluated all benefit programs for facility based treatment.
Education:
Bachelor’s Degree in Business
Wilmington College, Wilmington, OH
