Utilization Management Nurse Resume

Teresa Fay

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

Work Experience:

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

Example #2

Leslie Serna

16987 W Hammond St

Kingsbury, TX 78638


[email protected]

Objective Seeking to expand my experience as an Utilization Management Nurse and to enhance my skills & competencies and to serve people

Career Profile:

  • 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.

Nursing Experience:

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.

Academic Background

Health Care Quality & Management Board Certification, 2004

Rush University, Chicago, IL

B.S in Nursing, 2003

University of Washington, Seattle, WA

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