Utilization Management Nurse Cover Letter

I submit this application to express my sincere interest in the utilization management nurse position.

Previously, I was responsible for clinical review and decisions including but not limited to: physician and member appeals, member or provider information/education.

Please consider my qualifications and experience:

• Current RN licensure (unrestricted)
• Managed Care experience, discharge planning experience, and/or experience with Milliman Care Guidelines preferred
• Graduate of an approved NLN accredited School of Nursing
• Current RN licensed in the State of Ohio
• Experience with UR/UM in hospital acute care setting preferred
• Previous experience with Case Management, Utilization Review, or Interqual criteria preferred
• Knowledge of insurance guidelines and federal, state and local regulations preferred
• BSN and previous UR/UM experience preferred

I am excited to be applying for the position of utilization management nurse. Please accept this letter and the attached resume as my interest in this position.

Previously, I was responsible for insights & commentary of current & Outlook workforce reporting (including Capacity Creation) with clear linkages to drivers (inc.

My experience is an excellent fit for the list of requirements in this job:

• RN or LVN License
• Registered Nurse in good standing with an active state license
• Previous managed care experience desirable
• Knowledge of Medi-Cal & Medicare
• Communicate and interact appropriately with all internal and external customers
• Obtain and maintain current, active RN licensure in all states Permanente Advantage conducts business
• Working knowledge of all local, state and federal and regulatory requirements
• Excellent organizational, oral and written communication and problem-solving and decision making skills

I am excited to be applying for the position of utilization management nurse. Please accept this letter and the attached resume as my interest in this position.

In my previous role, I was responsible for correspondence, written and verbal, in accordance to policy and procedure for members with respect to status of pre-certification and utilization review.

Please consider my qualifications and experience:

• Knowledge of insurance guidelines and federal regulations preferred
• Registered Nurse with Behavioral Health experience
• Willingness to obtain RN licensure in other states as needed
• Registered Nurse licensed in state of Missouri, BSN preferred
• Proficient in the use of window-based computer programs
• Previous experience in a medical management or managed care setting with prior authorization experience preferred
• Proficiency with computer based programs such as Microsoft Word, Excel and SharePoint
• Models and supports effective team interactions

I am excited to be applying for the position of utilization management nurse. Please accept this letter and the attached resume as my interest in this position.

Previously, I was responsible for committee support to Medical Policy Committee, Utilization Management Committee, Policy Review Committee and Benefit Review Committee.

I reviewed the requirements of the job opening and I believe my candidacy is an excellent fit for this position. Some of the key requirements that I have extensive experience with include:

• Perform discharge planning and identifying alternate treatment programs
• Conduct episodic case management, consulting and collaborating with providers, members, and other resources as appropriate
• Assessing, planning, and implementing options and services require to meet an individual’s health needs within the scope of their benefit plan
• Current/active RN TN License
• Resolve non-standard requests and problems
• MIDAS, EPIC preferred
• UM Certification
• Demonstrated progressive leadership experience

I would like to submit my application for the utilization management nurse opening. Please accept this letter and the attached resume.

In my previous role, I was responsible for information to providers and members, including but not limited to coverage criteria and Medicare Part B benefit.

My experience is an excellent fit for the list of requirements in this job:

• Professional image and behavior
• Excellent windows-based navigation skills
• Experience with URAC and NCQA accreditation process
• Current, unrestricted Michigan Registered Nurse license
• Provide utilization management (such as prospective concurrent and retrospective review) integrated with clinical care management (such as case management, disease management, and/or care coordination) to best meet the member’s specific healthcare needs and to promote quality and cost-effective outcomes and appropriate payment for services
• Patient focused approach to problem solving, such as looking for opportunities to help each member achieve optimal health outcomes
• Strong customer service skills including listening, patience, empathy, maintaining confidentiality and focus on meeting customer needs
• Provides utilization management (such as prospective concurrent and retrospective review) to best meet the member’s specific healthcare needs and to promote quality and cost-effective outcomes and appropriate payment for services