RN-Utilization Review Cover Letter

Please consider me for the rn-utilization review opportunity. I am including my resume that lists my qualifications and experience.

In the previous role, I was responsible for feedback to Facility Case Management Director and Division Director of Case Management on issues related to utilization review and authorization/denial operations: offers input to Division Director on managed care contracting issues; best demonstrated practices; process improvement and utilization management activities; barriers to achieving goals and objectives of initiatives; participates in HCA Case Management and Division initiatives.

Please consider my experience and qualifications for this position:

• Minimum 1-2 yr Utilization Review experience preferred
• Proficiency with MS Office products such as Word, Excel, Outlook, and multiple systems
• Experience working in Behavioral Health
• Experience with Utilization Review and Mother/Baby strongly preferred
• Graduation from an accredited school of nursing with current licensure in the State of Indiana
• Thorough knowledge of medical and ancillary services necessary to utilize screening criteria as measured against the documented medical record with respect to patient needs for medical and health care
• Knowledgeable regarding medical terminology, appropriate levels of care, treatment and modalities, and the health care delivery system
• Knowledge of Interqual and Milliman guidelines /criteria, CMS and Joint Commission requirements related to corporate compliance

Please consider me for the rn-utilization review opportunity. I am including my resume that lists my qualifications and experience.

In the previous role, I was responsible for day-to-day oversight of Utilization Management operations, ensuring all practices and programs are aligned with the management team, directs the policies and procedures, and standards for utilization management operations.

Please consider my experience and qualifications for this position:

• At least 6 months hospital utilization management using Interqual or MCG
• Verbal, Grammar
• Interpersonal, Customer relations
• Mathematical, Reading, Comprehension
• Utilization review management experience preferred
• Prior Utilization Review experience from hospital or insurance company, preferred
• Competency in relationship building and social interactions
• Openness to change and willingness to try new approaches to problem solving

I am excited to be applying for the position of rn-utilization review. Please accept this letter and the attached resume as my interest in this position.

Previously, I was responsible for information regarding utilization management requirements and operational procedures to Care Coordinators, providers and facilities.

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

• Familiar with Utilization Management, Insurance Contracts, Documentation requirements and Appeals
• Valid unencumbered Texas RN licenseCompetent in Microsoft software
• Superior clinical judgement
• Current RN license issued by the State of New Hampshire Board of Nursing
• Strong knowledge of clinical UR and QA, Medicaid, Medicare guidelines and covered services
• Strong knowledge of InterQual/Milliman, MCG, ICD 10 Codes, and MCG Criteria
• Working knowledge of behavioral health, substance abuse and human service resources
• Assist non-clinical staff in performance of administrative reviews

Please consider me for the rn-utilization review opportunity. I am including my resume that lists my qualifications and experience.

In the previous role, I was responsible for pharmacist support for the drug prior authorization program by providing clinical expertise to Prior Authorization technician team to ensure review of prior authorization requests within all regulatory required time frames.

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:

• Serves as a presentation guide for walk-through surveyors, auditors, group representatives
• Graduation from an accredited school of nursing with current IN RN licensure in the State of Indiana
• Strong technology skills, being able to work out of multiple systems at one time
• Previous experience in utilization management and/or case management
• Experienced with MCG (Formerly Milliman) or Interqual
• Registered nurse with current MN license without restrictions or pending restrictions
• Familiar with process of reviewing cases for medical necessity
• Minimum Bachelors in Nursing, Master in Nursing or Public Health preferred

I submit this application to express my sincere interest in the rn-utilization review position.

Previously, I was responsible for strategic direction across functional responsibilities in accordance with requirements; regulatory, URAC, HEDIS, NCQA and future business related standards.

Please consider my qualifications and experience:

• Completion of RN program or related health care curriculum
• Demonstrates analytical and critical thinking abilities with proactive decision-making and negotiation skills, strong knowledge of governmental and private organization and community resources
• Minimum High School graduate or GED equivalent.- LPN or RN license in State of Arizona with business/revenue cycle experience preferred or equivalent experience in both a business and clinical setting
• Excellent interpersonal communication, conflict resolution, and negotiation skills are necessary
• Understanding of pre-acute and post-acute venues of care and post-acute community resources preferred
• Computer knowledge/experience is preferred
• Knowledge and background with Joint Commission and CMS CoP is highly beneficial
• Case Management Certification (ACMA)