A Utilization Manager undertakes responsibility for directing, planning, organizing, and u and related functions. A well-written Utilization Manager Resume mentions the following duties and responsibilities – developing and administering policies and procedures for utilization control of inpatient and outside referral services countywide; assisting in development and implementation of procedures to track and trend specialty; monitoring referral patterns, and making recommendations. Duties also include maintenance of good community relationships with providers, preparing statistical and narrative reports as requested by administrative staff; and training professional clinic and program staff.
The most sought-after skills for the post include the following – knowledge of state regulations applicable for treating and reimbursement, proficiency of medical and surgical diagnoses, and experience in utilization review in a hospital or healthcare setting. A degree and valid license is required to work in this capacity.
Objective : Cutting edge skill, the best knowledge and health care of patients, families and their communities. Skills checklist include administrative case management, care coordination, UR, discharge planning, clinical nursing and health and fitness. Clinical expertise in nursing areas of medical-surgical, cardiac/telemetry, rehabilitation, home health, and behavioral health.
Skills : Articulate, Intelligent And Great Communicator.
Description :
Contracted assignment for very large facility in Shenandoah blue ridge mountains.
Referred all first-level review failures to the SGH or other POC for further review and disposition.
Verified eligibility of beneficiaries using Defense Eligibility Enrollment Report System (DEERS).
Maintained Outpatient Psychiatrist and Nursing Schedules for all Outpatient Consumers to ensure all residents were seen within appropriate timeframes.
Created Utilization Review System for the facility to include all insurances and all programs serviced through the agency.
Trained therapist on Utilization Review System to ensure compliance by each member of the department Maintained therapist spreadsheet to ensure therapist were aware of upcoming revisions to treatment plans, behavioral health assessments, etc.
Oversaw all Outpatient audit processes: monthly chart audits, creating auditing tools, overseeing physical audits, completing corrective action plans, etc.
Experience
2-5 Years
Level
Executive
Education
Masters Of Arts
Utilization Manager Resume
Objective : Multifaceted, motivated Utilization Manager professional seeks a leadership position where my strong organizational skills and educational background can be utilized to maximum potential. Brings experience in leadership, planning, and ability to work well both independently and as a collaborative team member with a focus on building positive relationships and achieve results.
Skills : Trauma Informed Care, Dual Diagnoses Treatment, 40 Hour Rape Crisis Domestic Violence Training, Eye Movement Rapid Desensitization.
Description :
Developed and implemented a comprehensive Utilization Management plan/program in accordance with the facility's goals and objectives.
Performed data/metrics collection on identified program areas; analyzes and trends results, including over- and underutilization of healthcare resources.
Identified areas for improvement and cost containment.
Reported utilization patterns and provided feedback in a timely manner.
Performed medical necessity review for planned inpatient and outpatient surgery; and performed concurrent review to include length of stay for the facility's inpatients using appropriate criteria.
Reviewed previous and present medical care practices for patterns; trended incidents of under- and over-utilization of resources incidental to providing medical care.
Acted as referral approval authority for designated referrals per local/AF/DoD/national guidance and standards.
Experience
2-5 Years
Level
Executive
Education
MBA In Management
Utilization Manager Resume
Headline : Seeking a Utilization Manager position of Social Services Coordinator with an organization where my collaboration skills and experience of organizational practices can be applied to facilitate program objectives.
Skills : Organizational, Collaboration, Program Management, Program Coordination.
Description :
Focused on meeting the needs of publicly funded healthcare programs such as Medicare and Medicaid.
Delivered services to members with Outpatient Pre Certification needs such as Physical/Occupational/Speech Therapy, Durable Medical Equipment, and Pain Management.
Reviewed clinical documentation and pairing with criteria to be able to determine Medical Necessity.
Able to identify and determine procedures using Current Procedural Terminology Codes (CPT) and Healthcare Common Procedure Coding System numbers (HCPCS).
Able to provide services to Medicare and Medicaid members.
Led a team that included multiple levels of clinicians and non-clinicians with a goal of providing pre and post service reviews in an effective and cost appropriate manner.
Managed the primary development of the new lines of business, including detailed workflow of all areas to ensure NCQA, Department of Insurance compliance and Quality Assurance initiatives.
Experience
5-7 Years
Level
Junior
Education
Associates of Science
Utilization Manager Resume
Objective : To obtain a Utilization Manager position with an organization that will allow me to use the knowledge I have obtained through previous employment and education.
Skills : Health Care Management, Performance Evaluation.
Description :
Responsible for, but not limited to, training, supervising, motivating, and evaluating Utilization Review, Precertification, and Case Management Staff.
Ensured the day to day duties and overseeing the operation of the Utilization Staff.
Reviewed the precertification request from the physician's office, along with outgoing letters and daily spreadsheets for denials and non-precertified cases.
Discussion of daily hospital census with the rounding nurses, which includes opportunity day and intervention cases.
Worked with the Personal Care Coordinators to ensure continuity and coordination of care for the high-risk members.
Worked with the Utilization Management team in writing Benefit Interpretations and Technology Assessments.
Monthly Board reports are completed for the Health Services Director along with overseeing the completion of the weekly finance report.
Experience
2-5 Years
Level
Junior
Education
BSN
Utilization Manager Resume
Headline : To obtain an interesting Utilization Manager position with a growing company where I may utilize my skills and experience to gain knowledge and move up in the company.
Skills : Customer Service, Management SKills.
Description :
Collected and transferred patient clinical information to precertification staff of multiple insurance carriers and governs patient demographics and surgery authorizations.
Created ad hoc reports from internal databases and manages projects through the entire project lifecycle.
Interfaced with patients, insurance carriers, hospital personnel, and physicians regarding procedures, surgeries, and additional relevant data.
Streamlined utilization process for surgery approvals and improved turnaround time in addition to coaching new utilization and billing employees.
Reduced peer-to-peer discussion requests from 24+ to 3 annually through diligent documentation.
Detailed and thorough documentation has better-utilized physician hours and reduced patient wait times.
Surgical/Medical Billing Specialist (Dual Position) Liaises directly with Medicare, Medicaid, workers compensation, and a variety of MVA and commercials claims to ensure correct processing.
Experience
5-7 Years
Level
Executive
Education
BS
Utilization Manager Resume
Headline : Responsible for Monitoring the performance of clinical staff and implemented control systems to ensure effectiveness and efficiency, and also Facilitating educational training for clinical staff on documentation and issues.
Provided utilization review activities for all levels of behavioral health care, including inpatient, residential, partial hospitalization, intensive outpatient, and outpatient authorization requests with contacts to facilities and providers as needed to accomplish this task.
Promoted and provided quality service delivery and effective discharge planning for optimal member health outcomes.
Coordinated peer reviews with New Direction Behavioral Health Physician consultants on clinical cases that are not meeting the medical necessity criteria.
Demonstrated clinical expertise in response to a variety of circumstances ranging from crisis intervention to routine business matters.
Coordinated treatment planning creation of crisis prevention plans with treatment team as needed as part of the utilization review process.
Presented clinical cases to staff and consulting providers upon request of supervisor and as required by policies, and procedures.
Completed appropriate documentation in clinical systems in compliance with regulatory and accreditation standards.
Experience
5-7 Years
Level
Executive
Education
Mental Health Counseling
Utilization Manager Resume
Objective : Dedicated and focused Utilization Manager Professional who excels at prioritizing, completing multiple tasks simultaneously, and following through to achieve project goals. Seeking a role of increased responsibility and authority.
Skills : Microsoft Office, Coordinating Skills, Developing Skills.
Description :
Ensured cost-effective and quality consumer care.
Developed and implemented the agency's quality management system, including both its internal quality assurance and improvement activities.
Developed the agency's annual quality improvement plan and ensuring the effective implementation of policies and procedures for credentialing and supervision of staff.
Conducted orientation sessions and arranged on-the-job training for new employees Monitored services and assurance of the safety of Individual served and effective outcomes Directed and coordinated the supportive services department of the agency.
Prepared and reviewed operational reports and schedules to ensure accuracy and efficiency.
Analyzed internal processes, recommended and implemented procedural or policy changes to improve operations.
Reviewed and analyzed all clinical staff documentation to evaluate quality.
Experience
2-5 Years
Level
Executive
Education
Bachelor's In Psychology
Utilization Manager Resume
Summary : More than 13 years of successful experience in ocean freight related to service and support with recognized strengths in customer service, terminal operations, vessel allocation management, and problem resolution/avoidance. Proven ability to train, motivate, supervise, and manage employees. Advanced in positions of increasing responsibility for a 13-year tenure.
Skills : Customer Service, Microsoft Suite, Analytical Analysis, Data Entry, Supervisor.
Description :
Utilized a trauma-informed approach in all client interactions.
Adhered to the organization's infectious control policies and standards.
Documented observed patient behaviors and facilitate community meetings.
Performed clinical interventions as needed.
Collected, analyzed, interpreted, and summarized data, to include record reviews, client surveys, and service evaluations, for all CUA supports and services in a timely manner.
Identified and estimate defects in the quality system process.
Provided written and verbal reports and analysis of findings.
Experience
10+ Years
Level
Senior
Education
MBA In Management
Utilization Manager Resume
Objective : Seeking a Utilization Manager position with an outstanding career opportunity that will offer a rewarding work environment along with a winning team that will fully utilize management skills.
Skills : Microsoft Office, Strong Client Relations, Typing 70 WPM.
Description :
Authorized funding for inpatient psychiatric admissions for the indigent population of Travis County.
Secured psychiatric beds for patients in the community, ER's, and/or Psychiatric Emergency Services.
Managed admission, provided concurrent reviews, discharges, and coordination of aftercare.
Included extensive data entry into a large client database.
Served as the local mental health authority gateway for all Order of Protective Custody court submissions.
Kept up to date on local, state, and federal laws applicable to mental health confidentiality and involuntary psychiatric admissions.
Worked as a liaison between the local Mental Health Authority and Austin State Hospital (also Seton and Austin Lakes).
Experience
2-5 Years
Level
Executive
Education
M.Ed. In Counseling
Utilization Manager Resume
Summary : Innovative Utilization Manager professional with a strong track record for managing cross-functional teams that work collectively to achieve organizational goals. Skilled administrator and leader with excellent presentation, interpersonal, and written communication skills. Risk-taker with verifiable strengths in critical thinking, decision making, and problem-solving.
Skills : Program Research, Program Development, Program Evaluation, Organization, Problem Solving, Personnel Management, Behavior Management, Case Management, Case Documentation, Public Relations, Computer Skills.
Description :
Assisted support staff and program director with dispute resolutions and performance counseling processes.
Developed and implemented treatment plans based on clinical experience and knowledge for the CORE Team consumers.
Assembled, analyzed, and interpreted new/updated information about the consumer in order to reassess treatment needs.
Identified unmet needs, reviews available resources, and modifies the treatment plan as indicated.
Monitored consumer progress, review notes in sharenote for compliance with the service plan with APS.
Kept up to date on HIPAA compliancy laws.
Traveled to Alpine every other weekend to maintain a small private caseload, hence the overlap of dates with this and the previously listed job.
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