1620 Whispering Pines Circle
Dallas, TX 75247
Objective To secure a position as an Utilization Management Nurse in a premier medical center and to use my past experiences in the present work environment to better enhance the center.
Summary of Skills:
- Huge clinical care experience in health insurance industry
- Deep knowledge of concurrent review, utilization management, and discharge planning
- Sound knowledge of Medicare and Milliman Care Guidelines
- Proficient in MS Office suite and health care documentation systems (EPOCH, Clinical Care Advance, Med Decision)
- Strong communication and interpersonal skills
- Superior organization and time management skills
- Outstanding ability to interpret policies and procedures and communicate effectively
- Remarkable ability to make decisions and exercise good judgment in a complex environment
Utilization Management Nurse, August 2005 – Present
UnitedHealth Group, Dallas, TX
- Maintained medical standards for all clients based on their individual health benefit plans.
- Conducted pre-certification, retrospective, out of network and appropriateness of treatment setting reviews within scope of licensure.
- Developed relationships to help improve health outcomes for members.
- Ensured compliance to rules and regulation established by management.
- Documented review information in computer and communicated results to claims adjusters.
- Recorded and reported all information within scope of authority.
Utilization Management Nurse, May 2000 – July 2005
WellMed, Dallas, TX
- Implemented utilization management nursing functions.
- Supervised current inpatient service management.
- Monitored medical interventions for inpatients.
- Provided healthcare benefits to patients via utilization management nursing services.
- Assisted and supported inpatients in obtaining finance and insurance benefits.
- Evaluated inpatient and outpatient services to determine medical appropriateness.
- Gathered and organized medical data to process medical benefits to patients.
AA in Health Care Administration, Lake-Sumter Community College, Leesburg, FL
16987 W Hammond St
Kingsbury, TX 78638
Objective Seeking to expand my experience as an Utilization Management Nurse and to enhance my skills & competencies and to serve people
- Excellent problem-solving and decision-making skills.
- Solid organization, task prioritzation, and delegation skills.
- Extensive experience in utilization review, quality assurance, discharge planning and other cost management programs.
- Wide knowledge of modern nursing principles, techniques, and procedures for the care of patients.
- Immense ability to demonstrates self motivation, time management and communication skills.
Utilization Management Nurse, 2004 to till date
Good Samaritan Hospital, Baltmore, MD
- Answered direct telephone calls related to medical services.
- Reviewed current inpatient services and determined medical appropriateness of inpatient and outpatient services.
- Advised and counseled to precertification staff.
- Analyzed patient records, and participated in interdisciplinary collaboration with professional staff.
- Identified solutions to non-standard requests and problems.
Health Care Quality & Management Board Certification, 2004
Rush University, Chicago, IL
B.S in Nursing, 2003
University of Washington, Seattle, WA