Review Manager Resume Sample
Alice Schamberger
501 Gerhold Causeway,
Chicago,
IL
+1 (555) 777 8495
Work Experience
Utilization Review Manager
02/2016
-
PRESENT
New York, NY
- Draw accurate conclusions from written or verbal information, identify links between component parts and spot trends in information, think conceptually to see how something fits into a wider system and take a holistic/‘bigger picture’ view while paying attention to details
- Responsible for determining training needs and administer the programs to meet those needs
- Provides direct daily supervision including hiring, evaluation, training, disciplinary action, coaching, counseling and termination actions with direct reports
- Supervises the review of case files
- Microsoft office proficiency in Word, Outlook and Excel
- U.S. citizenship (required for federal security clearance)
- Initiate performance improvement for prioritized processes or outcomes, as indicated
Periodic Review Manager
02/2010
-
01/2016
Los Angeles, CA
- Develop measures which are meaningful to improvement efforts and are indicators of performance and success
- Analyze data to identify opportunities for improvement and confirm the success of improvement efforts, with special focus on National Patient Safety Goals, Core Measures and survey preparedness
- Apply performance improvement skills in clinical outcomes, satisfaction and operational processes within the organization
- National Patient Safety Goals oversight
- Function Organization and Structuring
- Relies on experience and judgment to plan and accomplish goals. (Encompasses all of the bank’s residential and commercial real estate lending.)
- Manage outsourced contracts including relationships with suppliers (TCS and Genpact) and sourcing
- Work with Operations & Finance to collect and review modeling inputs
Review Manager
10/2002
-
10/2009
New York, NY
- Drive input quality improvement
- Drive process simplification and integration
- Support extended modeling team
- Drive modeling uniformity through close collaboration with the rest of the global Modeling team as well as with the Technology & Productivity organization, Finance, Operations and Commercial teams
- Training staff in the use of Hospital’s designated level of care criteria
- Interviews and evaluates assigned staff performance including annual performance reviews, performance improvement plans and disciplinary steps pursuant to Hospital’s Human Resource policies and procedures
- Ensures Case Management Nurses are notified of any denials obtained during a patient’s hospitalization
- Hires, trains, and develops a team of EDD Specialists responsible for AML/BSA risk scoring and enhanced due diligence reviews on the bank’s highest-risk customers
Education
Strayer University - Prince George's Campus
1997 - 2002
Bachelor's Degree in Accounting
Professional Skills
- · Strong Organization skills and able to proactively prioritize needs and effectively manage resources
- Excellent communication and interpersonal skills with the ability to effectively and
- Comfortable instructing and working with staff to develop strong technical skills
- Computer experience required with skills including but not limited to Microsoft Windows, spreadsheets, and word processing
- Possess business acumen, strong communication (both oral and written), interpersonal and analytical skills
- Strong organizational and/or project management skills to coordinate departmental projects & to perform multiple projects or tasks simultaneously
- Excellent issue spotting and problem-solving skills
How to write Review Manager Resume
Review Manager role is responsible for microsoft, organization, compensation, retail, finance, credit, training, integration, mac, auditing.
To write great resume for review manager job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Review Manager Resume
The section contact information is important in your review manager 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
- Telephone number
Work Experience in Your Review Manager Resume
The section work experience is an essential part of your review manager 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 review manager responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular review manager position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Review Manager resume experience can include:
- Evaluate the control environment, including the Manager’s Control Assessment (MCA) results, and identify risk factors and perform root cause analysis to provide recommendations and workable solutions
- Experience conducting professional Plan Reviews and/or complex Building Inspections on a UC Campus
- Experience inclusive of branch banking, project management and business analysis
- Three (3) years experience with an insurance carrier and/or TPA performing medical bill review in the Workers’ Compensation arena
- Able to manage multiple competing priorities
- Demonstrates a commitment to teamwork and cooperation; communicates accurate information timely; collaborates with Physician Advisor
Education on a Review Manager Resume
Make sure to make education a priority on your review manager resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your review manager 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 Review Manager Resume
When listing skills on your review manager 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 review manager skills:
- Can work effectively in a team environmentEffectively manage multiple deadlines and projects
- · Computer skills – demonstrates proficiency in Microsoft Office, Excel, MS Outlook, Midas, Meditech, On Base
- Good interpersonal skills, diplomatic demeanor and ability to motivate
- Effectively and proficiently communicate both verbally and in writing in a highly professional manner
- Respond effectively to appeals
- Computer skills: Outlook and knowledge of the Microsoft Office Suite
List of Typical Experience For a Review Manager Resume
1
Experience For Utilization Review Manager Resume
- Oversite of the teams’ performance of UM reviews that involve the assessment of medical necessity, quality of care, level of care and appropriateness of health care services for plan members
- Experience at managing a small team
- Assists review committee in planning and holding federally mandated utilization reviews, periodic medical reviews and professional reviews
- Confers with subordinates regarding dispositions of problems
- Keeps informed of patient disease processes and treatment modalities through reading clinical literature
- Interpret and apply measure definitions in abstracting data
- Analyze data to identify improvement opportunities including the use of statistical analysis, charts and graphs
- Supports the teams’ effort and acts as a guide for adherence to Cognizant/Client SLA’s
2
Experience For Quality Review Manager Resume
- Makes decisions to support quality and productivity outcomes
- Models appropriate behaviors and actions at all times. Applies clinical review criteria, guidelines, and screens in determining the medical necessity of health care services against the clinical data provided
- Consistently manages all work within the regulatory and contractual timeframes
- Performs data analysis related to Utilization Review metrics; develops, implements and monitors action plans related to denial reduction, timely authorizations, concurrent denial letter scan rates, and other identified UR metrics
- Proceeds on manager’s initiative, in compliance with HCA standards, professional standards of practice and policy and procedure, to resolve identified issues
- Develops and revises, implements, monitors, and evaluates processes to ensure outcomes are achieved related to managed care contracts; appropriate authorizations or determinations of medical necessity for all payers sources are obtained and documented
3
Experience For Periodic Review Manager Resume
- Initiates and facilitates collaboration with hospital staff, PAS, managed care with a goal of contract compliance and decreasing payer denials or non-medically necessary days at the facility level
- Develop, review, and implement policy and procedure
- Identifies process improvement opportunities; develops, revises, implements, and monitors action plans
- Collaborates with physician advisor and medical staff to ensure quality outcomes and reduction in denials
- Provides leadership to and actively participates with facility staff to identify, implement, or enhance UR programs consistent with HCA and division strategy
- Performs staff supervision to validate policy, procedure and standards are met; collaborates with Division Director prior to performing wide-spread records reviews
- Provides input to managed care department on utilization management activities and communicates to staff
- Provides oversight to concurrent appeal strategy within the payer process
4
Experience For Plan Review Manager Resume
- Schedules and manages meetings with payers for collaboration and process improvement
- Assists Physician Advisor and division leadership with the identification of documentation improvement opportunities
- Functions as a core team member of the Denial Management Action Team
- Maintains a current knowledge of InterQual Criteria
- Familiar with Joint Commission, State and Federal standards/requirements
- Knowledgeable about third party payer source criteria of medical necessity
5
Experience For Gcg-branch Oversight Function Review Manager Resume
- Organized and able to meet deadlines consistently
- Establish and maintain the Bank's appraisal standards to ensure that all real estate appraisals and evaluations align with legal and regulatory requirements. Stay abreast of industry legal and regulatory changes and expectations to ensure appraisal standards and procedures remain up to date and compliant
- Establish and maintain workflow processes and procedures to ensure
- Closely monitor and report on overall progress, productivity, and accuracy of the project and individual contract document review lawyers
- Lead and motivate contract document review lawyers throughout the document review project
- Train contract document review lawyers on the use of document review platforms
6
Experience For Collateral Review Manager Resume
- Identify and mentor team leads
- Identify and define production set and work with case team and operations to ensure that production sets are accurate and delivered per production specifications
- Manages a team of Collateral Reviewers
- Conducts team huddles and staff meetings
- Adjusts job descriptions when needed
- Contacts AMC on issues of quality and service levels
- Assists with daily emails from the Equity and Mortgage lines to answer concerns and look for amiable resolutions
- Manages Time and Attendance
- Creates daily email for colleagues to direct them on the day’s work flow
7
Experience For App Review Manager Resume
- Daily inventory management of team case load
- Manage reviewer supervisor team
- Lead aspects of quality control of the program
- Work to create efficiencies and cut cost on program
- Supervises and trains subordinate staff in methods and practices pertinent to their assignments
- Interviews, selects, hires, orients, evaluates, counsels and recommends discipline of subordinate staff
- Reviews and analyzes governmental and accrediting agency standards governing admissions, treatment and continued stay of patients to develop policies and procedures
8
Experience For Scientific Review Manager Resume
- Analyzes individual patient records to determine validity of admission
- Reviews patient treatment plans to ensure adherence to established criteria and standards
- Refers cases to Utilization Review Committee for review and course of action when case fails to meet criteria
- Serves as review committee liaison with other hospital committee in development of policies and procedures
- Supervises and coordinates activities of utilization review staff in maintenance of informed policy and procedure manuals, files, records and correspondence
9
Experience For Appraisal Review Manager Resume
- Manage, coordinate and control the overall operation of the Utilization Management Department
- Manage and coordinate the integration of the Utilization Management Department's functions with other aspects of overall patient care
- · Ability to work independently with little to no supervision
- Manage review department
- · Some travel required
10
Experience For Senior Margin Review Manager Maternity Leave Replacement Resume
- Understands basic management approaches such as work scheduling, prioritizing, coaching and process execution, work organization, risk management and delegation
- Understands Blue Shield of CA’s mission and business plan
- Has functional expertise within the area of responsibility
- 3-6 yrs working experience- Supervises scientific review officers (SROs) assigned to individual peer review panels. - Guides SROs throughout the peer review process, including reviewer recruitment, meeting facilitation and summary statement writing. - Serves as the primary poi
- Knowledge of psychiatric program delivery and medical necessity criteria
- Demonstrates the ability to perform the technical skills and critical thinking required to achieve performance improvement results, such as data collection and analysis knowledge. Knowledge of Performance Improvement methodology(s)
List of Typical Skills For a Review Manager Resume
1
Skills For Utilization Review Manager Resume
- Proven ability to interpret and execute review project objectives and provide substantive project guidance/coaching
- Accounting experience
- National real estate valuation experience
- Managerial/supervisory experience
- Experience in an acute care hospital setting
- Skilled at internal and external audits
2
Skills For Quality Review Manager Resume
- Knowledgeable and experienced in utilization management and review
- Experience in utilization management with a health plan, worker’s comp or hospital based UM department
- Experience with MCG or Interqual criteria set
- Recent supervisory experience
- Typically, requires advanced knowledge of job area usually obtained through advanced education combined with experience
3
Skills For Periodic Review Manager Resume
- · InterQual experience required
- · Third Party denial experience helpful
- Two years of experience in case management, utilization management or related field
- Knowledge of InterQual or related evidenced based criteria sets
- OPM Background Investigator Case Review experience
4
Skills For Plan Review Manager Resume
- Review management experience
- Direct OPM experience
- Making a move? We offer relocation assistance
- Working knowledge of GAAP, Financial statements and collateral analyses
- Understanding of internal control framework testing and monitoring
- Familiarity with concepts and application of statistical sampling, email threading, near duplicate identification, clustering, and predictive coding
- Able to use experts to assist in process of reviewing files, writing reports and developing recommendations
5
Skills For Gcg-branch Oversight Function Review Manager Resume
- Enjoy working in state of the art/newly renovated nursing units
- Our wide-ranging benefit package is designed to empower your total well-being
- Supports the hiring and onboarding of staff
- Analyzes new and resolved denial volume for tracking and trending and assist in preparation of documentation for SSC payer meetings
- Assists with new hire and ongoing training for the Review team
- Proficiency or ability to quickly acquire proficiency working with commercial review platforms (i.e., OmniX,
- Extensive knowledge of US GAAS and Government Auditing Standards
6
Skills For Collateral Review Manager Resume
- Knowledge of IFRS and/or International Standards on Auditing
- We value continued learning and offertuition reimbursement
- Dedicated to nursing excellence and patient-centered care, we have a collaborative approach to quality and safety
- Frequent same day travel for work at clients' offices using a personal vehicle
- Able to work moderate overtime throughout the year with heavier overtime required during certain business cycles
- Extensive knowledge of USPAP guidelines and general appraisal techniques and analysis and banking regulations
7
Skills For App Review Manager Resume
- Knowledge of Lending Operations and/or Appraisal Department policies and procedures
- Familiarity of Motivational Interviewing theory and practice
- Provides for job coaching and performance improvement of subordinate staff
- Assist in creation of monthly results reporting to senior management and the larger
- Execute multiple components of the internal Branch Review QA process, including
- Proficient with Microsoft Excel, particularly the use of formulas, pivot tables, and basic formatting
- Works and runs the daily Triage meeting
- Develop action plans for underperforming colleagues and provide timely feedback
- Attention to detail with the ability to multi-task and work well in a fast paced
8
Skills For Scientific Review Manager Resume
- Motivation – able to manage a small team to deliver and improve
- Customer service and responsiveness
- Extensive knowledge of US GAAP, principally FASB
- Knowledge of ProFX Engagement
- Our employees enjoy competitive salaries
- Get started on the right foot with our comprehensive orientation process
- Specialty specific educators provide valuable mentorship
9
Skills For Appraisal Review Manager Resume
- Adept in use of core technical tools including Microsoft Office (Word, Excel, PowerPoint, Outlook), Bank loan underwriting and servicing systems and web-based interface with appraisal processes
- Seasoned supervisory RN in managed care as a Utilization Review Nurse, Discharge Planner or Case Management Nurse
- Management Certification (PMP, Six Sigma, Company Secretary)
- Additional domain expertise (e.g., technical , scientific) or fluency in a language other than English
- Able to meet deadlines and performance metrics
- Capacity to learn new excel templates quickly
- Occasional out-of-town travel with overnight stays for work at clients' offices
- General appraisal techniques and analysis experience knowledge of the various government/city requirements affecting real estate valuation (e.g. tax credits, certificate of occupancy approvals)
10
Skills For Senior Margin Review Manager Maternity Leave Replacement Resume
- · Demonstrates ability to foster a team building environment
- · Leadership – guides the department toward desire outcomes, setting high performance standards and delivering quality services
- Working with Microsoft Word, Excel, Access, PowerPoint and Outlook
- · Communication – communicates professionally, clearly and concisely
- · Knowledge of The Joint Commission Standards and other regulatory bodies
List of Typical Responsibilities For a Review Manager Resume
1
Responsibilities For Utilization Review Manager Resume
- Proficient use of graphics to identify and represent data. (Excel)
- Interpret graphical representations of data
- Legal qualifications highly regarded
- Provide direction and support to staff
- · Registered Nurse
- Implements and monitors regulatory requirements, HCA Ethics and Compliance policies, and quality initiatives related to UR services; provides regulatory and compliance updates to staff, provides standards of practice updates, initiates / drives process changes to ensure compliance to such regulations and quality initiatives as it relates to Utilization Review
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