Nurse Reviewer Cover Letter

I submit this application to express my sincere interest in the nurse reviewer position.

Previously, I was responsible for medical oversight for scientific review and approval of promotional and medical materials in compliance with corporate standards and government/industry regulations.

My experience is an excellent fit for the list of requirements in this job:

• Current licensure in the State of Texas
• PowerPoint and Access experience and basic statistical knowledge preferred
• Experience in SNF and/or home health care preferred
• Registered Nurse (RN) active license
• Writes articles for newsletters as requested and participates in provider training as needed
• Knowledge of Uniform Bill and coding desirable
• Knowledge of Interqual or Careweb criteria for level of care desirable
• Prior experience in prior authorization, home care, and working with disabled or long term care populations strongly preferred

Please consider me for the nurse reviewer opportunity. I am including my resume that lists my qualifications and experience.

In my previous role, I was responsible for continuity and consistency of care by building positive relationships between member and family, physicians, provider, care coordinator, and health care plan.

Please consider my experience and qualifications for this position:

• Follows project escalation plan regarding site follow up for outstanding source documentation
• Uses the electronic adjudication system, or other related systems for tracking, running reports, or viewing endpoint data
• Supports the Project Manager in the collection of project metrics related to source document collection and clinical review
• Keeps Project Manager apprised of any potential/actual project issues and develop solutions for same
• Processes requests from Endpoint Adjudication Committee Members for additional information
• Reviews documentation changes, or additional documentation received post adjudication for relevance and the need for re-adjudication
• Assist in training/mentoring of new employees, ensuring that they are performing clinical review per established procedures with minimal rate of error
• Identifies out of scope activities and process efficiency/improvement needs to management

Please consider me for the nurse reviewer opportunity. I am including my resume that lists my qualifications and experience.

Previously, I was responsible for clinical direction, supervision, and support to the clinical review team’s determination of eligibility and/or authorize services for members in accordance with program guidelines and regulations.

Please consider my qualifications and experience:

• Requires a minimum of LPN or LVN
• Current and unrestricted DE RN licensure
• Preferred hospital medical necessity reviewer in-patient expertise
• Bilingual skills (English/Spanish) is a great asset
• Strong communication skills (verbal, written and aural)
• Willingness and aptitude to learn new skills across all CEVA service lines
• Occasional lifting and moving of objects
• Assists the Project Manager in the development of project specific procedures, and workflows, as requested

I submit this application to express my sincere interest in the nurse reviewer position.

In my previous role, I was responsible for programmatic and clinical oversight to the Aging Service Access Point (ASAP) network promoting program compliance with The Executive Office of Elder Affairs and MassHealth regulations.

My experience is an excellent fit for the list of requirements in this job:

• Communicates with the study team (ie sites, CRAs, Committee Members) as necessary regarding the endpoint source document requirements and collection process
• Assists with project specific process/system training for study team (ie sites, CRAs, Committee Members), as directed by Project Manager
• Attends internal and external project team meetings as needed
• Provides input to the development and review of study documents (ie Site Manual, Procedure Manual, Adjudication Forms) as requested by Project Manager
• Processes source documents as necessary
• Provides clinical judgment during the review of source documents to determine if the information is sufficient for the reported clinical endpoint to be adjudicated
• Redacts project specific clinical data from source documents as necessary
• Issues and closes site queries for outstanding source documentation, per Procedure Manual

I would like to submit my application for the nurse reviewer opening. Please accept this letter and the attached resume.

In the previous role, I was responsible for solutions to complex clinical problems through analysis, identification of programs, and opportunities for improvement to align with strategic plan of Steward Health Care Network and Care Management leadership.

My experience is an excellent fit for the list of requirements in this job:

• Assists in ensuring audit readiness
• Experience utilizing Interqual criteria in the review process
• Requires knowledge of Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including HMO, PO and POS plans
• Knowledge and understanding of the property/casualty insurance industry and healthcare delivery system preferred
• Provide strategic leadership and direction for the delivery of services to clients/customers and team members
• Perform training needed to deliver service improvements and enhance customer experience
• Maintain regular communication with clinical team members to provide productivity and quality statistics and obtain feedback on operational functions
• Act as a clinical resource to non-clinical staff