Passionate and enthusiastic nursing professional with expertise as a Referral Management Nurse.

  Patient advocate, with valuable, hands-on experience as a Charge Nurse and mentor to colleagues.

  Experience with claim or chart reviews, appeals and revenue recovery best practices.

  Stellar time management, attention to detail and organizational skills, including prioritizing tasks.

  Perform tasks with the utmost integrity and ethical standards.

  Strong knowledge of state and federal regulations; Milliman Guidelines; HMO and PPO health insurance policies and plans; and the Health Insurance Portability and Accountability Act (HIPPA).

Referral Management Nurse, Healthcare Partner s/DaVita Costa Mesa, CA 2010-2014

  Earned excellent marks on last performance review with the organization.

  Spearheaded Utilization Management/Care Management Services in a high-volume setting.

  Ranked No. 1 against peers in terms of volume for output of referral letter, requiring no overtime.

  Worked closely with the Medical Director to send up to 15 denial and 20 pending letters daily to patients.

  Recognized as the go to person for up to 12 utilization coordinators with questions.

  Gained the trust of management to enable utilization coordinators to approve referrals.

  Trained, mentored and coached utilization coordinators on best practices of operations.

  Avoided falling behind and not meeting compliance guidelines by creating a notation in the system altering utilization coordinators of Pending Letters Due By which improved workflow.

Clinical Instructor/Nurse Educator, California Career Institute Garden Grove, CA 2009

  Educated Licensed Vocational Nurses (LVNs) on best practices of providing care at skilled nursing facilities or hospitals, including using mannequins to demonstrate real life scenarios.

  Instructed students on medical terminology as well as medical abbreviations.

  Focused lectures on ensuring that students captured the essence of providing exceptional patient care.

RN Case Manager, Orange Coast Memorial Hospital Fountain Valley, CA 2005-2007

  Demonstrated strong leadership skills and gained the trust of management to oversee healthcare for all Kaiser Permanente members admitted to any unit within the hospital, from 20 to 42 patients per day.

  Oversaw all utilization management and discharge planning tasks, including any necessary follow up.

  Referred high-risk patients to the appropriate Case Manager and acted as resource for patients and their families to community resources.

  Worked closely with representatives from Apria Healthcare to re-organize the hospital's durable medical equipment (DME) closet, which lacked system processes and controls.

  Authored How to Manage a DME Closet in a 2006 issue of hcPro's, Case Management Monthly, which documented how the DME closet was re-organized to meet the needs of patients and the hospital.

Ambulatory Case Manager, Monarch Healthcare 2003-2005

  Oversaw referral authorizations, denials, appeals and high dollar claim and chart reviews.

  Averaged between 80-130 referral authorizations or more daily, as well as up to 20 denials per day.

  Referred high-risk patients to the appropriate Case Manager.

Admissions Manager Supervisor, Preferred Excellent Care 2000-2003

  Communicated effectively with home infusion pharmacists and technicians.

  Ensured patients were eligible for home infusion coverage based on their insurance plan.

RN Case Manager, Fountain Valley Regional Hospital and Medical Center Fountain Valley, CA 1994-2000

  Showcased solid leadership skills to oversee healthcare for all patients admitted to any unit at the hospital.

  Oversaw all utilization management and discharge planning tasks, including any necessary follow up.

Bachelor of Science, Nursing (BSN), graduated with Honors

Montana State University

Associate of Arts (AA)

Miles Community College

Licensed Registered Nurse, State of California, License No. 64980411981

Nurse Educator Certified, California School of Health Sciences; earned Mar. 2008

Dear Hiring Manager:

With this letter, I wish to express my strong interest in joining your organization as a (INSERT SPECIFIC JOB TITLE HERE).

As demonstrated in the accompanying resume, I am a passionate and enthusiastic nursing professional with expertise as a Referral Management Nurse. I am a patient advocate, with valuable, hands-on experience as a Charge Nurse and mentor to colleagues. My experience includes claim or chart reviews, appeals and revenue recovery best practices. In this capacity, I have a proven track record of stellar time management, attention to detail and organizational skills, including prioritizing tasks. Among my unique qualifications and skills:

  Earned excellent marks on last performance review with Healthcare Partner s/DaVita.

  Spearheaded Utilization Management/Care Management Services in a high-volume setting.

  Ranked No. 1 against peers in terms of volume for output of referral letter, requiring no overtime.

  Recognized as the go to person for up to 12 utilization coordinators with questions.

  Trained, mentored and coached utilization coordinators on best practices of operations.

  Strong knowledge of state and federal regulations; Milliman Guidelines; HMO and PPO health insurance policies and plans; and the Health Insurance Portability and Accountability Act (HIPPA).

As your healthcare leader, you will find me to be a team player committed to providing exceptional care to patients. I have no doubt that I would be a valuable asset to your operations, and look forward to interviewing with you in the near future.

Sincerely,

Yyyyyy x. yyyyyy

xxx-xxx-xxxx