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Yyyyyy x. yyyyyy

13360 Maxella Ave., Unit 4

Marina Del Rey, CA 90292

abc@xyz.com

 

 

 

Utilization Review/Management ~ Insurance Case Management

 

Profile

 

  Extensive case management and utilization review background supporting both insurance and clinical sectors, with credentials including:

  Certified  Case Manager (CCM); exp 2019

  California  Registered Nurse, License  #A420689; exp. 2/28/2019

  State of Florida Registered Nurse, License # 9458947/Control # 2434137; exp. 4/30/2019

  BLS Certified

  Member, American Case Management Association

  Expertise in standards of care, best practices, policies and procedures, regulatory compliance, appropriate bed days based on conditions, discharge planning, insurance, and ICD 10

  Vast experience in working with insurers to coordinate care, provide clinical information, secure bed days authorizations, and facilitate/certify discharge plans

  Expert knowledge of Medi-Cal and California Children s Services guidelines

  Specialization in Neonatal/NICU and Pediatric nursing, diagnoses and outcomes

  Technology savvy, with proficiency in EPIC, InterQual and specialty case management systems

  Excel in strategically planning, coordinating and managing caseload/workflow to maximize productivity and efficiency while maintaining high quality standards

 

Career Track

 

Los Angeles Cedars Sinai Medical Center 1996-Present
Inpatient Case Manager, Level 3 Neonatal Intensive Care Unit and High Risk OB Unit; 2010-Present

  Optimize use of resources, cost controls and quality assurance through strategic case management, with accountability for approximately 20-50 cases across units; productively collaborate with cross-functional medical teams, insurers and related stakeholders to achieve goals

  Effectively apply in-depth knowledge of levels of care spanning standards, best practices and policies and procedures through discharge planning; define appropriate bed days per patient condition

  Successfully consult with insurance providers in areas including coordination of care, certification of inpatient days, discharge needs, and ICD 10; additionally assist patients with insurance issues

  Expertly conduct reviews, advise unit management on level of care criteria, lead discharge planning rounds, and educate physicians and nurses on appropriate documentation

  Actively determine if patients meet criteria for California Children/s Services and complete referrals

Inpatient Case Manager, Medical Surgical Units; 1996-2010

  Proficiently managed Med-Surg cases throughout medical center and across all levels of care; included standards, best practices, policies and procedures, and optimal bed days based on patient conditions

  Effectively managed patient charts, records and documentation; included ICD 10

 

Earlier Experience - details on request

 

Sr. Home Health Coordinator/Supervisor Central Intake, Los Angeles Visiting Nurse Assoc.; 1991-1996

Staff Nurse, Department of Women Health, Cedars Sinai Medical Center-Los Angeles; 1987-1991

Staff Nurse, Department of Women Health, Northside Hospital-Atlanta, GA; 1982-1987

 

Education

 

BSN, Valdosta State College, School of Nursing-Valdosta, GA

 

Yyyyyy x. yyyyyy

13360 Maxella Ave., Unit 4

Marina Del Rey, CA 90292

abc@xyz.com

 

 

 

Date

 

 

 

Hiring Agent Name

Title

Company Name

Address

City/State/Zip Code

 

Dear__________________:

 

I am currently seeking a challenging career opportunity in a (INSERT ACTUAL TITLE OF THE TARGET POSITION) capacity and am submitting my resume for your review. In advance, thank you for your time and consideration.

 

As demonstrated, I offer vast case management and utilization review experience which includes an extensive background in working closely with insurers across care coordination, clinical information/documentation, bed days certification, and discharge planning, with a consistent focus on delivering quality care while controlling costs, optimizing use of resources and ensuring standards compliance. I excel in facilitating best practices, policies and procedures as well as implementing strategies to maximize performance and achieve aggressive goals. Of note, I am also well-versed in regulatory guidelines and varied industry technologies.

 

Additionally, I am a Certified Case Manager who holds both State of California and State of Florida Registered Nurse licenses, and am an active member of the American Case Management Association. Complementing this, I previously earned a Bachelor of Science in Nursing from Valdosta State College School of Nursing.

 

As an employee, you will find me to be a performance-driven leader and collaborative team player prepared to deliver immediate and long-term results and committed to supporting you in achieving your objectives. I am confident that I could be a valuable asset to your organization, and look forward to interviewing with you in the near future.

 

Sincerely,

 

 

 

Melissa Friedman, RN, CCM

 

 

 

 

 

Yyyyyy x. yyyyyy

13360 Maxella Ave., Unit 4

Marina Del Rey, CA 90292

abc@xyz.com

 

 

 

 

Date

 

 

 

Contact Name

Company Name

Address

City/State/Zip Code

 

Dear _______________________________:

 

I would like to thank you for providing me the opportunity to interview with you and discuss the exciting (TITLE OF POSITION APPLYING FOR) position currently available with your company. Having gained a deeper insight into the job requirements and your objectives, I am confident you will find me a valuable asset in achieving your goals.

 

As discussed, my vast case management, utilization review and clinical background should translate to dynamic results as a member of your team. In particular, I believe you will find my expertise in (ADDRESS A FEW SKILLS/QUALIFICATIONS/ ACHIEVEMENTS RELEVANT TO THE POSITION WHICH YOU DISCUSSED DURING THE INTERVIEW) vital to your immediate and long-term objectives.

 

Should you have any additional questions, or to further discuss this opportunity, please feel free to contact me at your earliest convenience. Again, thank you for the enlightening interview. I look forward to your response and am eager to contribute to your success.

 

Professionally,

 

 

 

Melissa Friedman, RN, CCM

 

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