Resume

Utilization Review Nurse Resume Example & Writing Guide

Use this Utilization Review Nurse resume example and guide to improve your career and write a powerful resume that will separate you from the competition.

Utilization review nurses are tasked with assessing patient care plans, identifying potential areas of overuse or misuse of services, and helping to identify areas of improvement within an organization. They do this by reviewing patient records, identifying areas that could benefit from modification, and suggesting ways to improve patient care.

Because utilization review nurses are often tasked with reducing costs while maintaining quality care, they need to be skilled at identifying resources that can be cut without impacting patient outcomes. They also need to be capable of identifying opportunities to save money without sacrificing quality or service.

If you’re interested in working in health care but haven’t yet found your dream job, here’s some tips and an example resume template for reference when writing your own resume.

Michael Garcia
Los Angeles, CA | (123) 456-7891 | [email protected]
Summary

Skilled utilization review nurse with more than 10 years of experience in the health insurance industry. Proven ability to assess medical necessity, identify potential fraud, and manage authorizations. Excels at collaborating with providers and developing positive relationships with clients.

Education
University of California, Davis Jun '10
B.S. in Nursing
Experience
Company A, Utilization Review Nurse Jan '17 – Current
  • Reviewed medical records and clinical data to determine the appropriate level of care for patients based on established criteria, regulations, and standards.
  • Conducted utilization reviews (UR) in accordance with Medicare guidelines and applicable state laws/regulations regarding patient eligibility for services or continued benefits.
  • Assessed the appropriateness of requests for non-emergency hospital admission by reviewing available information such as physician orders, test results, etc., to ensure that all requirements are met before authorization is granted.
  • Provided education to physicians, other health care providers, patients, families about Medicare coverage rules and regulations related to specific diagnoses or procedures when requested by a provider or beneficiary.
  • Participated in quality improvement activities including but not limited to chart audits, peer review meetings, training programs designed to improve performance and enhance knowledge base within specialty area(s).
Company B, Utilization Review Nurse Jan '12 – Dec '16
  • Conducted utilization reviews for inpatient and outpatient services, including medical necessity of care, appropriateness of treatment plan, and cost-effectiveness
  • Provided education to patients on the process of a review and how their individual needs may be different from others’
  • Collaborated with physicians to determine appropriate level of care based on patient’s condition and available resources
  • Reduced hospital costs by identifying unnecessary or inappropriate treatments that could be replaced with less expensive alternatives
  • Improved quality of life for patients through more efficient use of healthcare resources
Company C, Nurse Jan '09 – Dec '11
  • Provided direct patient care, including assessment, diagnosis, planning, intervention, and evaluation.
  • Collaborated with other members of the healthcare team to ensure optimal patient care.
  • Participated in quality improvement initiatives to ensure the delivery of evidence-based care.
Certifications
  • Certified Utilization Review Nurse
  • Certified Case Manager
  • Certified in Long-Term Care
Skills

Industry Knowledge: Utilization Management, Case Management, Utilization Review, Medical Necessity, Case Resolution
Technical Skills: McKesson, Epic, Cerner, Meditech, Clinical Documentation Improvement, ICD-10, CPT/HCPCS, ICD-9, CPT, HCPCS, EHR, Meaningful Use, EMR
Soft Skills: Critical thinking, Problem-Solving, Decision Making, Teamwork, Communication, Empathy, Leadership

How to Write a Utilization Review Nurse Resume

Here’s how to write a utilization review nurse resume of your own.

Write Compelling Bullet Points

Bullet points are the most effective way to showcase your experience and qualifications. But rather than simply listing your responsibilities, you can make your bullet points much more interesting and compelling by using specific numbers and statistics.

For example, rather than saying you “provided patient care,” you could say that you “provided care for 15 patients during 8-hour shift, resulting in 98% satisfaction rating from patients and their families.”

The second bullet point is much more specific and provides a clear picture of what you did and the outcome of your work. It also provides a quantifiable result—a 98% satisfaction rating—which is always a good thing!

Identify and Include Relevant Keywords

When you submit your resume for a utilization review nurse role, it’s likely that it will be scanned by an applicant tracking system (ATS) for certain keywords. This system looks for terms that are specific to the job, like “utilization review” or “underwriting.” If your resume doesn’t include enough of the right terms, the ATS might automatically reject your application.

To increase your chances of landing an interview, use this list of commonly used keywords as a starting point for writing your resume.

  • Utilization Review
  • Nursing
  • Healthcare
  • Healthcare Management
  • Medicare
  • Home Care
  • Hospitals
  • Acute Care
  • Patient Safety
  • Medication Administration
  • Electronic Medical Record (EMR)
  • Patient Education
  • Patient Advocacy
  • IV Therapy
  • U.S. Health Insurance Portability and Accountability Act (HIPAA)
  • Basic Life Support (BLS)
  • Inpatient Care
  • Advanced Cardiac Life Support (ACLS)
  • Health Information Technology (HIT)
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Care Coordination
  • Respiratory Therapy
  • Pulmonary Disease
  • Critical Care Nursing
  • Cardiopulmonary Resuscitation (CPR)
  • Cardiac Arrest
  • Adult Critical Care
  • Nursing Education
  • Medication Adminstration Certification
  • Healthcare Information Technology (HIT)

Showcase Your Technical Skills

Nurses in utilization review need to be proficient in the use of technology to review patient charts and make decisions about treatment. They also need to be familiar with medical coding and billing procedures, as they will often be responsible for billing patients for their care.

Some of the programs and systems that utilization review nurses are typically expected to be proficient in include: electronic health records (EHR) software, medical coding and billing software, and patient monitoring systems.

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