Review Nurse Cover Letter

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

Previously, I was responsible for support and backfill for program integrity clinical support activities, as needed, including review and development of fraud/waste/abuse cases.

I reviewed the requirements of the job opening and I believe my candidacy is an excellent fit for this position. Some of the key requirements that I have extensive experience with include:

• Commitment to continuously provide quality services to all customers
• Computer literacy in MS Word, Excel
• Unrestricted Registered Nurse licensure in DE
• Proficiency utilizing Microsoft Office Suite (Word, Excel, Power Point), Internet applications, and EMRs
• Strong organization skills and effective oral and written communication skills
• Demonstrates interpersonal communication skills with and between the interdisciplinary healthcare team
• Proficient computer skills (i.e., Word, Outlook, Excel, ), familiarity in Cerner EMR navigation
• Demonstrates working knowledge of payer/regulatory guidelines and national standards for medical necessity such as InterQual and Milliman Care Guidelines

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

In the previous role, I was responsible for support to internal staff, subcontractors and providers with respect to Medicare and/or Medicaid related issues.

Please consider my experience and qualifications for this position:

• Auto claims experience preferred
• Direct experience on a healthcare provider team
• Current unrestricted licensure as a registered nurse (RN) with the State of Ohio which allows conducting an assessment independently as permitted within the scope of practice
• Familiarity with workers’ compensation laws, rules and policies
• Performs initial, concurrent, and/or retrospective review of services that require prior authorization or medical appropriateness review using health plan benefits, clinical appropriateness criteria, or plan guidelines/protocols
• Maintains knowledge of regulatory requirements
• Participate in case review and/or team meetings with managerial team and Medical Director
• Knowledge of medical appropriateness criteria such as InterQual®, Milliman Care Guidelines®

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

Previously, I was responsible for timely and accurate responses to inquiries from the claim policy teams in relation to courtesy pre-determination requests, claims pending for medical review and appeal inquiries.

Please consider my experience and qualifications for this position:

• Experience with utilization review criteria and/or progression of care guidelines
• Experience with hospital inpatient admission/observation criteria
• Excellent problem identification, problem-solving skills, and follow through skills
• Extensive computer familiarity
• Excellent computer navigation
• Some knowledge of billing and coding
• Unrestricted Illinois Registered Nurse license
• Experience with MCG (Formerly Milliman) or Interqual

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

In my previous role, I was responsible for clinical and coding guidance to Fraud and Abuse department.

Please consider my experience and qualifications for this position:

• Active Connecticut State Registered Nurse or Licensed Practical Nurse
• Able to work in multiple computer systems
• Concurrent review experience
• Previous UR/discharge planning experience preferred
• Chart review experience helpful
• Experience working with Outlook, Skype, Excel, MS Word
• Reliable, self-motivated and a team player
• ABQAURP certification is preferred

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

In the previous role, I was responsible for medical direction and serves as a medical resource for claims teams regarding new claims determinations, additional allowances on claims, compensation requests and claim reactivations.

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

• Evaluates admissions and continued stays for appropriate level of care and medical necessity using approved criteria through the utilization of the electronic medical record
• Identifies patients with the potential for high risk complications and makes appropriate referrals to the facility Case Management team acting as an advocate for the individual's healthcare needs
• Residence within the West Florida Division market area
• Current state licensure as a registered nurse or licensed vocational nurse
• Occasional lifting, caring, pushing and pulling of up to 25 pounds
• Working knowledge of Medicare regulations for charging and billing
• Active New York State Registered Nurse (RN)
• BSN or CCM preferred or to be achieved in first 12 months of employment