Utilization Management Cover Letter

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

In my previous role, I was responsible for denial reports on a monthly, quarterly, and requested basis to the Care Management Department, Patient Financial Services, Managed Care Contracting, Revenue Cycle, and hospital leadership including the CEO.

Please consider my experience and qualifications for this position:

• Knowledge of medical terminology, ICD-10
• Work experience in healthcare setting with familiarity of Home and Community Based (HCBS) waivers, experience in Utilization management and familiarity with Medicaid preferred
• Strongly prefer medical assistant, home health aide, nursing assistant, or other similar health care para-professional training or certification
• Medical Terminology highly recommended
• Currently enrolled in a health care related field of study preferred
• Demonstrated knowledge of medical terminology, ICD-10
• Knowledge of insurances and managed care
• Demonstrates willingness to assist others

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

Previously, I was responsible for input to managed care department on utilization management activities and communicates to staff.

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:

• Foster excellent working relationships with all stakeholders
• Experience working in a Case/Care Management department
• Experience working with individuals with mental health or substance use disorders
• Independently or in a team, should be able to identify the root issues and formulate potential solutions
• Prefer someone in MST Zone
• Knowledge of regulatory and accrediting standards relating to medical management and managed care
• Knowledge of medical terminology and claims processing
• Creative problem - solving and communication skills

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

Previously, I was responsible for direction and oversight to ensure effective management of inpatient care, discharge planning, and prior authorizations for medical or behavioral health.

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:

• Complete pre-certification for HLOC admissions
• Complete retro-reviews and retro-authorizations for inpatient and/or emergency services
• Makes self-available to daytime and afterhours clinical team for questions or guidance on UM activities
• Complete quarterly chart audits of Utilization Management Staff
• Monitor consistency among UM staff in application of level of care criteria
• Assist with referral and triage process and review all emergent cases with Director of UM and Physician Advisor
• Complete annual performance review of UM staff
• Monitor UM caseloads/workload and performance

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

Previously, I was responsible for consultation to health care teams by analyzing ethical/care issues and appropriate theoretical principles providing guidance as appropriate.

Please consider my qualifications and experience:

• Update and educate staff of any changes to policies and procedures
• Review monthly UM performance metrics and collaborate with UM Director, Manager and Supervisor for data analysis and quality and performance improvement strategies
• Coordinate and help facilitate monthly staff meeting with UM Manager/Supervisor
• Coordinate with UM Manager/Supervisor and help facilitate weekly case conferences with Medical Director, Health Plans and Case Management
• Hiring and termination of department staff
• Training new staff regarding utilization management process, workflow and policies and procedures
• Develop relationship and function as a back-up liaison with payers, providers and facilities
• Knowledge of medical necessity and treatment protocols for psychiatric and chemical dependency treatment

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

Previously, I was responsible for professional and administrative leadership for social workers and care coordinators responsible for providing complex care coordination services to high risk patients with diverse insurances.

Please consider my experience and qualifications for this position:

• Able to work effectively and achieve results in a real time, fast paced environment
• Analytical skills with strong organization skills
• Job requires sitting for prolonged periods
• Working experience with MCG or Integral evidence based guidelines highly preferred
• Experience with computer skills with Windows information systems/computer workstation preferred
• Experience with telecommunication equipment and office equipment/supplies preferred
• Medical assistant, home health aide, nursing assistant, or other similar health care para-professional training or certification
• Registered Licensed clinical professional counselor (LCPC), Licensed Professional Counselor (LPC), or Licensed Clinical Social Worker (LCWS)