Utilization Review Nurse Resume Sample

Utilization Review Nurses handle inpatient cases to ensure that health care services administered are necessary, have cost efficiency, and are within compliance. They work behind the scenes to maximize the quality and cost of care, patient care overall plans, and often work with patients by educating them on the benefits and limitations of various insurances.

For many, writing a resume can be daunting. If you are working on your own, it is easy to become overwhelmed with the amount of information you need to include and how best to present yourself.

The sample resumes below provide great examples of how to write an effective resume.

The Best Utilization Review Nurse Resume Samples

These are some examples of accomplishments we have handpicked from real Utilization Review Nurse resumes for your reference.

Utilization Review Nurse Resume Sample 1

  • Reviewed patient’s health records and medical history to create a timeline of the current condition.
  • Promoted effective healthcare practices by ensuring utilization review standards were met as defined in national treatment guidelines.
  • Recorded vital information from patients’ charts, interpreted results, identified test procedures to be completed, and scheduled appointments for patients.
  • Educated patients on their diagnoses and possible treatments, as well as what to expect during the course of their hospital stay.
  • collaborated with physicians, case managers, and other medical staff to ensure continuity of care for patients.

Utilization Review Nurse Resume Sample 2

  • In charge of managing Utilization Review Team to ensure that health care services were provided when and where needed.
  • Successfully completed concurrent reviews for medical necessity and appropriateness of services with an outstanding accuracy rate.
  • Partnered with other departments to resolve patient complaints and improve customer service.
  • Received commendation award from Department Manager for excellent teamwork and leadership skills.
  • Recognized by upper management for developing a new process to improve turnaround times for physician-related communication.

Utilization Review Nurse Resume Sample 3

  • Conducted thorough and timely reviews of inpatient and outpatient medical records to ensure compliance with the approved utilization guidelines established by Medicare, Medicaid, and private insurers.
  • Recognized for demonstrating commitment toward attaining fiscal responsibility through effective review practices.
  • Known for fostering positive relationships with physicians, hospital administrators and staff, and other referral sources.
  • Visited hospitals to ensure compliance with utilization guidelines.
  • Collaborated and communicated effectively with physicians, other healthcare professionals, and patients.

Utilization Review Nurse Resume Sample 4

  • Monitored, analyzed, and evaluated patient symptoms, conditions, medications, surgery outcomes, treatments received.
  • Reversed over 30% of all negative trends following hospital admission by recommending changes to treatment plans after obtaining patient files from physicians.
  • Interacted with peer physicians in team-based care environments to enhance treatment plans and establish new nursing protocols.
  • Recognized for exemplary performance by physicians, nurses, and all staff members; organizing success of unit-wide seminars promoting compliance with HIPPA standards.
  • Achieved 100% accuracy in diagnosis using patient information for directing medical attention to prevent unnecessary deaths while reducing costs associated with hospital stays.

Utilization Review Nurse Resume Sample 5

  • Administered pre-certification, certification, and recertification nurses for home health care services to patients in need of skilled nursing assistance.
  • Received the Patient Satisfaction Program Award for exceeding patient satisfaction goals during quality review process.
  • Administered utilization review policies for reimbursement of patient cases under Medicare conditions.
  • Provided the average reviewer with accurate, timely, and comprehensive information to certify home health care patients.
  • Collaborated with internal stakeholders to update policies related to pre-certification of home health care services.

Utilization Review Nurse Resume Sample 6

  • Provided clinical consultation to physicians and insurance providers for case management.
  • Attained award for excellence in patient care, safety, and clinical outcomes.
  • Assisted independently in performing UR functions including examining medical records, making determinations regarding treatment or referrals for patients, resolving issues with patient’s insurance providers, and responding to inquiries from patients.
  • Recognized as an expert in utilization review by being featured as a presenters at nursing conferences on UR topics.
  • Instrumental in developing and implementing new clinical programs and processes that improved patient care and safety.

Utilization Review Nurse Resume Sample 7

  • Effectively educated patients and physicians on Medicare guidelines, contractual obligations, and coverage requirements for post acute care.
  • Established a collaborative relationship between physician offices and assisted living facilities to facilitate quality of care provision through quality reports.
  • Facilitated the coordination of medical treatments following extended hospitalization by working with the interdisciplinary team and physicians to develop a care plan.
  • Reviewed patient charts for appropriateness of admission, continued stay, and discharge to prevent unnecessary hospitalizations and ensure compliance with Medicare regulations.
  • Received commendation from Director of Utilization Review for excellent clinical review skills, exceptional customer service, and notable contribution to the improvement of patient care.

Utilization Review Nurse Resume Sample 8

  • Provided high-quality customer service to patients in the inpatient setting, in compliance with Utilization Management guidelines.
  • Earned an “Above and Beyond Award” for excellence in customer service.
  • Reviewed medical records for accuracy and completeness.
  • Identified clinical areas of concern through utilization review of patient charts.
  • Worked collaboratively with case managers and physicians to ensure appropriate care for patients.

Utilization Review Nurse Resume Sample 9

  • Reviewed medical records and spoke with physicians, patients, and families to ensure appropriate admissions.
  • Acted as a liaison between the hospital and payers by explaining the necessity for hospital services.
  • Assessed risks or complications, which may arise from an illness or injury, by reviewing physician orders and following up with physicians.
  • Reviewed discharge planning to ensure that patients received the necessary post-acute care.
  • Maintained an excellent knowledge of utilization review policies and procedures.

Utilization Review Nurse Resume Sample 10

  • Evaluated findings of surgical procedures to determine current medical necessity for treatment, complications, risks, potential adverse reactions, and side effects.
  • Monitored patient’s progress against improvement goals in order to make recommendations for changes in treatment or care plans.
  • Promoted positive communication with residents by providing guidance on post-operative activities and restrictions.
  • Supported the healthcare team in providing compassionate care to patients and families by acting as a liaison between family members, physicians, and hospital personnel.
  • Assisted providers in identifying effective and efficient processes for managing patient flow through utilization review process; increased capacity to manage departmental workflow.

Utilization Review Nurse Resume Sample 11

  • Analyzed and evaluated clinical documentation to ensure appropriate level of care and services were being delivered to members.
  • Reviewed treatment plans and tests orders for appropriateness and medical necessity.
  • Presented detailed clinical reviews to Physicians, case managers and other health care professionals.
  • Monitored utilization of services and resources to ensure compliance with State and Federal guidelines.
  • Demonstrated exceptional knowledge of medical policies and clinical practice by achieving certification as a Utilization Review Nurse.

Utilization Review Nurse Resume Sample 12

  • Conducted concurrent reviews for appropriateness of services and medical necessity of inpatient admissions, tests, and treatments.
  • Analyzed and interpreted physician documentation to support clinical decision-making.
  • Reviewed physician orders for correct coding, billing, and compliance with regulatory requirements.
  • Effectively collaborated with patients, physicians, and ancillary services to identify care gaps.
  • Inventoried the utilization of services rendered in a five-hospital local network for analysis of cost, reimbursement, and effectiveness.

Utilization Review Nurse Resume Sample 13

  • Created an online training program and updated handbook on Utilization Management.
  • Presented at the American Health Information Management Association annual conference; received an award for “Excellence in Quality.”
  • Received “Nurse of the Year” honors; recognized as a top performer in nursing practices, documentation, and resource management.
  • Recognized as a clinical expert with three years of leading performance; skilled in treatment plans, meeting compliance requirements, and resolving client issues.
  • Led the implementation of comprehensive discharge planning for patients during interdisciplinary rounds.

Wrap Up

A Bachelor’s Degree is required, along with a Utilization Review certification. The URN will consult with medical care teams, analyze patient stays, oversee the timely completion of diagnostics, coordinate with Social Workers, insurance companies, and senior staff members with timeliness, compassion, and efficiency.

Resumes are a crucial aspect of any job search. In order to make a good first impression, it is important that your resume be formatted and written professionally. To create the perfect resume, think about what skills and qualities you want your future employer to see.

Hope these samples gave you an idea of what your resume should look like and some tips on how to make sure that your resume stands out from the rest.

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