Utilization Management Nurse resume examples

Choose and edit as your own

Get inspired by the best resume examples picked for your profession and create your!

Add pre-written phrases

Describe yourself as a professional just in 2 clicks! All the phrases you need are prepared by us

Save and Download your Resume

Save it in PDF format. Ready-to-sent to you employer!

This resume is created in 7 minutes.
Professional Summary
Innovative, customer-oriented healthcare clinician with background in managed, ambulatory and long-term care. Strong background in quality assurance, claims analysis and management principles and practices. Seeking a leadership role within an integrated delivery system.
  • Strong presentation skills
  • Effective staff coach
  • Quality improvement competency
  • Medicaid Management Information Systems
  • Independent judgment and decision making
  • Analytical thinker
  • Resource management expertise
  • Knowledge of Medicaid statutes and regulations
  • Promotes positive behavior
  • Planning and development
Work History
Telephonic Care Manager, 09/2013 to Current
AmeriHealth Caritas Family of Companies Philadelphia, PA
  • Processed monthly reports for department performance.
  • Coordinated Quality Improvement Activities (QIA's) to identify performance areas for improvement.
  • Authorized drug refills and provided detailed prescription information to pharmacies.
  • Specialized in the nursing care of patients with chemical dependency.
  • Effective counseling in health maintenance and disease management.
  • Developed patient care plans, including assessments, evaluations and nursing diagnoses.
  • Documented patient information obtained from interviews.
  • Managed care for post-operative patients through discharge.
Emergency Department Registered Nurse, 06/2008 to 10/2013
Howard University Washington, DC
  • Followed infection control procedures.
  • Developed and produced all office flyer notifications for important policy changes, office news and events.
  • Assessed need for, ordered, obtained and interpreted appropriate lab tests.
  • Counseled and educated patients about reproductive health issues and wellness. Expertise in STDs, HIV and family planning.
  • Performed lab tests and communicated results.
  • Extensive experience working in homes with disabled children and adults.
  • Assisted doctors with surgeries and non-invasive procedures.
  • Performed monthly inventory and maintained office and medical supply counts.
Utilization Management Nurse Consultant, 07/2008 to 11/2011
Medical Case Management Group Windham, , ME
  • Consulted and coordinated with health care team members to assess, plan, implement and evaluate patient care plans
  • Interviewed or corresponded with physicians to correct errors or omissions and to investigate questionable claims;
  • Observe nurses and visit patients to ensure proper nursing care.
  • Initiated audit process to evaluate thoroughness of documentation and maintenance of facility standards.
  • Administered job knowledge assessments and competency testing for certification-level training.
  • Managed and directed fiscal operations, including planning budgets, authorizing expenditures, accounting, establishing service rates and coordinating financial reporting.
  • Organized the department in accordance with administrative guidelines in order to provide specified nursing services to meet the legal, organizational and medical staff guidelines.
  • Continually maintained and improved the company's reputation and positive image in the markets served.
MBA: Healthcare Management, 2018 (Projected)
Ashworth College - Norcross, GA
Associate of Science: RN, 2008
Excelsior College - Albany, NY
Bachelor of Science: 2011
Ashworth College - Norcross, GA