Utilization Review Manager Home Care Resume

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Contact Information:

Full name

Present and permanent addresses

Telephone numbers

Email address

Objective:

Seeking a Manager level job in a prominent health organization to utilize various personal skills and making good rapport with the employer.

Career Profile:

Self-motivated, responsible, dedicated, and hard-working individual able to work in a fast-paced environment.

Education:

• Bachelor of Science Nursing, 1994, University of Phoenix, Salt Lake City, Utah
• Associates of Science Nursing, 1991, Boise State University, Boise, Idaho
• Practical Nursing Program, 1990, Southwest State Technical College, Alabama

Specialized in:

• Patient care coordinator/case manager-concurrent review
• Health care finder
• Home health care
• Utilization review @ hospital
• Agency nursing-staffing multiple hospitals (ICU and med-surg)
• ICU units
• Cardiac care units
• Skilled nursing units
• Med/surge units
• Taught Certified Nurse Aide Course and American Red Cross babysitting course

Experience:

Humana Military Healthcare Services, May 2001 – January 2006

Patient Care Coordinator/Case management

• Referral experience including: checking eligibility of customer, building referrals in msr-approving the family member if clinical meets the criteria and pending the active duty member to mmso (military medical support office) for approval after all clinical is obtained; apply interqual criteria when indicated.
• Complete referrals within specified time frame, negotiate cmac rates and enter proper documentation of providers acceptance or rejection of cmac rate, pend referrals to second level review, case management (with appropriate GOS code and adequate information) and to PFWD (program for persons with disabilities), when appropriate.
• Also send referrals to written prior authorization or HSM/AFO Medical Director when indicated.
• I know that admission review needs to be done within 24 hours of notification, using Inter- qual SI (severity of illness) and IS (intensity of service) and discharge review.

Trinity Hospice, September 1999 – October 2001

Registered Nurse

• Evaluated, amended and developed new format of peri-operative nursing notes and development of nursing peri-operative care plans
• Policy and Procedure: Review, evaluation and establishment of policies and procedures for clinicians
• Peer Review: Colleagues Supervision and Evaluations.

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