Medical Nurse Resume Sample

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Viva Beatty
4520 Borer Rue,  Los Angeles, CA
+1 (555) 961 0165

Work Experience

Nurse Medical Mgmt, / II / Senior
10/2015 - PRESENT
Phoenix, AZ
  • Prior telephonic medical management experience
  • Working knowledge in: Trimed or MCG
  • Provide hemovac care
  • Catheterize patients using straight catheter
  • Check for circulation, sensation and movement
  • Change non-sterile/sterile dressings
  • Provide urinary drainage foley catheter care
Medical Claim Review Nurse
11/2012 - 05/2015
Boston, MA
  • Florida RN licensed
  • Conducts ongoing assessment and improvement of the department’s performance. Promotes the Quality Management program of the facility maintaining appropriate quality control programs (where applicable). Oversees and drives performance in quality metrics, patient safety and clinical excellence initiatives
  • Incorporates the philosophy of the Department of Nursing and the hospital’s mission, vision and values and Five Indicators of success in the design and implementation of a plan for staff development, care delivery and unit growth
  • Ensures staff is educated on established guidelines for reporting significant medical errors or unanticipated outcomes in the patient’s care which results in patient harm
  • Occassional driving to site locations with occassional travel
  • Long varied work hours required occasssionally
Student Nurse Apprentice, Medical Oncology
09/2008 - 08/2012
New York, NY
  • Working knowledge in: Trimed, MCG, AIMS and CCB
  • Working knowledge in: TriMed, HRS and MCG
  • Successfully promote to Delegated Groups, patients’ participation in clinical programs - providing information on participation, Clinical Program availability/descriptions and facilitating members with program engagement
  • Monitor receipt of IPA’s required UM Delegation Reports
  • Accurately define gaps in Humana’s service relationship with providers and facilitate resolution
  • An understanding of terminology used in reports and documentation and internal systems
  • Adheres to internal quality control processes to assure the reliability of project reviews and meet and/or exceed The Company’s productivity and quality review standards
  • Assess patient’s baseline status and escalate relevant information to anesthesia as necessary
  • Gather and collate all physician H&P’s, orders, medical clearances etc


National American University - Sioux Falls
2002 - 2007
Bachelor's Degree in Nursing

Professional Skills

  • Performs thorough assessments of the assigned surgical patients. Assessments include obtaining patient history, assessing body systems, outcomes of treatments and procedures performed and the psychosocial needs of the patient
  • Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills
  • Also requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills
  • Demonstrate a proficiency in computer skills - Windows, Instant Messaging, Microsoft Suite including Word, Excel and Outlook
  • Social skills to positively engage with your patients, guests, physicians, and other employees
  • Provides training, leadership and mentoring for less experienced clinical peers and LVN, RN and administrative support staff
  • Experience using electronic documentation and using multiple computer screens

How to write Medical Nurse Resume

Medical Nurse role is responsible for facilitation, analytical, interpersonal, medical, computer, health, microsoft, excel, clinical, education.
To write great resume for medical nurse job, your resume must include:

  • Your contact information
  • Work experience
  • Education
  • Skill listing

Contact Information For Medical Nurse Resume

The section contact information is important in your medical nurse resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:

  • First and last name
  • Email
  • Telephone number

Work Experience in Your Medical Nurse Resume

The section work experience is an essential part of your medical nurse resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous medical nurse responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular medical nurse position you're applying to. The work experience section should be the detailed summary of your latest 3 or 4 positions.

Representative Medical Nurse resume experience can include:

  • Ensures member access to medical necessary, quality healthcare in a cost effective setting according to contract. Consult with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost effective care throughout the medical management process
  • Experience working with Microsoft Office (Outlook and Word)
  • Experience working within Managed Care
  • Experience with Outpatient Nursing (i.e. Durable Medical Equipment, Home Care, Physical Therapy, Occupational Therapy, Speech Therapy)
  • Experience working with Facets and Macess
  • Demonstrates the facility’s Standards of Performance, I HEART values, and Patient Promise

Education on a Medical Nurse Resume

Make sure to make education a priority on your medical nurse resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your medical nurse experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.

Additional details to include:

  • School you graduated from
  • Major/ minor
  • Year of graduation
  • Location of school

These are the four additional pieces of information you should mention when listing your education on your resume.

Professional Skills in Medical Nurse Resume

When listing skills on your medical nurse resume, remember always to be honest about your level of ability. Include the Skills section after experience.

Present the most important skills in your resume, there's a list of typical medical nurse skills:

  • Previous Utilization Management experience is strongly desired
  • Prior authorization and Concurrent Review experience
  • Experience working with PMG/IPA and FQHC Clinic, coordinating complex discharges
  • Be able to demonstrate a working knowledge and acumen of Microsoft Office products
  • Experience with clinical medical record auditing
  • Experience managing utilization management and case management processes

List of Typical Experience For a Medical Nurse Resume


Experience For Medical Claim Review Nurse Resume

  • Continued stay review, care coordination, and discharge planning for appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts
  • Responsible for the observation, assessment, nursing diagnosis, planning, intervention, and evaluation of care of all assigned patients, infant through life span in the Med/Surg unit
  • Promotes and maintains patient safety standards
  • ACLS certification required within 6 months of hire or promotion
  • Current BLS (All RNs)
  • Telephonic discussion with health care providers and / or members to explain benefit coverage determinations and to obtain additional clinical information

Experience For Medical Qualifications Nurse Resume

  • American Heart Association (Health Care Provider) upon hire
  • Registered Nurse/BSN required
  • Medical Necessity Review
  • Naged care products

List of Typical Skills For a Medical Nurse Resume


Skills For Medical Claim Review Nurse Resume

  • Average Manual dexterity of hands and fingers to operate a computer, computer keyboard, mouse, copier, fax machine, telephone, and other peripherals
  • Reviews provider reconsideration requests related to claim edits and validation outcomes
  • Previous Utilization Management experience in NICU required
  • A current/valid North Carolina RN license required or Nurse Licensure Compact (NLC) equivalency
  • Acute care clinical experience
  • Reviewing, analyzing, and rendering medical necessity coverage decision and appropriate referral to physician reviewers
  • Familiarity and thorough understanding of billing forms, RA’s, EOB’s and provider billing statements

Skills For Medical Qualifications Nurse Resume

  • Collaborates with providers to assess member’s needs for early identification of and proactive planning for discharge planning
  • The ability to be flexible and willing to adapt to an ever changing environment
  • Manage the review of medical claims, records, and authorizations for billing, coding and other compliance or reimbursement related issues
  • Collaborates with providers to assess members’ needs for early identification of and proactive planning for discharge planning
  • Supplies criteria supporting all recommendations for denial or modification of payment decisions
  • In acute care nursing and utilization review
  • Nursing practice in Med/Surg unit
  • Perform prospctive review of high dollar claims for benefit and pricing-determination
  • Work collaboratively with Finance to determine appropriateness of pricing

Skills For Nurse Medical Management Resume

  • Current Licensure with the TN State Board of Nursing
  • Current ACLS (All CCU, ER, Cath Lab, Special Procedures, PACU, House Supervisors, Float, Imaging, Endoscopy, EKG EEG)
  • Facilitates member care transition through the healthcare continuum and refers to medical director as required
  • Correctly interprets and applies appropriate regulatory requirements and standards
  • 1K joints per year

Skills For is Virtual Nurse Program Coordinator Adult Inpatient Unit-medical Resume

  • Educate, communicate, and coordinate with multiple patient care teams to ensure the patient receives quality care, a timely discharge, and to identify and resolve delays and issues
  • Needs to occasionally move about inside the office to access file cabinets, documents and files, etc
  • Helps with the development and implementation of proactive approaches to improve and standardize overall retrospective claims review
  • Performs clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases, in which an appeal has been submitted, to ensure medical necessity and appropriate/accurate billing and claims processing
  • Reviews medically appropriate clinical guidelines and other appropriate criteria with Medical Directors on denial decisions
  • Serves as a clinical resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals
  • Prepares and presents cases in conjunction with the Chief Medical Officers Medical Directors for Administrative Law Judge pre-hearings, State Insurance Commission, and Meet and Confers
  • Conducts pre-certification, continued stay review, care coordination, or discharge planning for appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts
  • Conducts pre-certification, inpatient, retrospective, out of network and appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts

Skills For Medical Review Nurse Resume

  • Experience with medical review and/or utilization management
  • Current unrestricted RN license in the State of GA required
  • Current unrestricted RN license in CA required
  • Background in Medical Review
  • Current unrestricted RN license in the state of California required
  • Current unrestricted RN license from the Commonwealth of Virginia required. A

Skills For Medical File Review Nurse Resume

  • CPR/BCLS is required on hire
  • Current, active unrestricted Nevada RN license
  • Current unrestricted RN license in the state of California, Colorado, or Nevada required
  • Current unrestricted RN license in the state of Indiana is required
  • Conducts pre-certification, care coordination for appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts
  • Acute Care Experience (i.e. ICU, ER)
  • Acute care, hospital case management, or utilization management experience desired

Skills For Medical Policy Analyst Nurse Resume

  • Recent Medical Surgical experience
  • Leadership/charge nurse experience
  • Receive and respond to inquiries from Claims, Prior Authorization, and Concurrent Review staff
  • Medical Review experience
  • Experience in FEP
  • Collaborates with providers to assess member's needs for early identification of and proactive planning for discharge planning
  • Multi-task and switch gears quickly and comfortable working in a productivity environment with a work queue

Skills For Nurse Medical Mgmt, / II / Senior Resume

  • Proficient with using a computer
  • Current unrestricted RN license from applicable state(s) required
  • Current unrestricted RN license in Georgia, Indiana or Virginia is required
  • Current unrestricted RN license in the State of Washington
  • Commute daily to our Richmond, VA office
  • PALS Certification required within 6 months in department (New Graduates within 12 months of hire)
  • New employees have up to 6 months from date of hire to obtain ACLS & PALS

Skills For Medical Clearance Nurse Gi-boca Raton Outpatient Surgery & Laser Center Resume

  • New RN graduates have up to 12 months from date of hire or transfer to RNA/RN position to obtain ACLS &PALS
  • Knowledge of Managed care programs and practices required
  • NLC (Nurse License Compact) RN license or have an RN license in an eNLC state and can apply
  • Familiarity with Milliman Care Guidelines or Interqual
  • The ability to work seamlessly and independently in multiple computer platforms

Skills For Medical Clearance Nurse Resume

  • This is an hourly position (non-exempt) with option to work at home
  • Utilize standard methodology and medical criteria sets to analyze and interpret member and/or provider claims, eligibility and quality data
  • Identify potential process modification, changes, or automation to improve performance, quality, and efficiency
  • Implement and maintain production and quality standards for he medical review process
  • Maintain departmental records, correspondence and files
  • Assist with other clinical function of medical review
  • Certificates as requested by department

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