Utilization Review Nurse Cover Letter

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

In my previous role, I was responsible for information and education on quality and performance improvement processes to medical supervisory staff.

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:

• Nurse with active unrestricted license in USA
• Experience in Prior Authorization preferred
• MS Office Experience Preferred - Specifically MS Excel
• Knowledge of medical/pharmacy terminology/coding and managed care processes
• Graduation from an accredited nursing education program
• Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ) preferred
• Current active unrestricted CA RN License
• If LPN, relevant experience in discharge planning and evaluation in a hospital setting

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

Previously, I was responsible for insight and direction to management on any compliance concerns regarding products, company policies and procedures and/or client specifications.

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:

• Knowledge of managed healthcare programs - HMO, PPO, and POS are preferred
• Current/valid State of Florida Registered Nurse (RN) license
• Current BLS (Basic Life Support) certification from the AHA (American Heart Association)
• Possesses effective interpersonal skills, can work across departmental boundaries and facilitates problem resolution
• Knowledge of the functional operations of utilization management, care coordination and transitions of care
• Available to work a flexible schedule to meet organizational needs
• Excellent communication, consultancy, facilitation and conflict resolution skills
• Experience and knowledge of HMO, PPO, TPA, PHO and Managed Care functions

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

Previously, I was responsible for educational assistance to providers and physicians regarding covered and non-covered care for medical/surgical and/or psychiatric claims, as well as appropriate network utilization.

Please consider my experience and qualifications for this position:

• Clinical expertise maintained through periodic CEU course attendance
• Active RN license in the state of AL
• Prior clinical experience preferably in an acute care and home health
• Excellent customer service skills and exceptional telephone etiquette
• Overall understanding of payer contracts and government/regulatory compliance
• Understands payer guidelines, reimbursement methodologies, and appeals process
• Commercial or managed care payer background
• Active Florida Registered Nursing license

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

In my previous role, I was responsible for education to employees around medical necessity and supporting documentation as indicated from regulatory standards.

Please consider my qualifications and experience:

• Should not be easily frustrated and should be able to cope with disappointment
• Demonstrated competency utilizing healthcare data
• May serve as a preceptor for new employees
• Knowledge of Medicare & Medi-Cal guidelines
• Current BLS card per Registered Nurse (RN) Case Manager contract requirements
• Current physical exam per state or Registered Nurse (RN) Case Manager contract requirements
• Graduation from an accredited school of nursing with current RN licensure in the State of Indiana
• Previous experience preferred in case management, utilization review, quality management and/or discharge planning

In response to your job posting for utilization review nurse, I am including this letter and my resume for your review.

In the previous role, I was responsible for nursing and medical services to students emphasizing health promotion, health maintenance, illness management, and disease prevention.

Please consider my qualifications and experience:

• Knowledge of precertification and/or medical review processes in a health care payor or third party
• Proficiency with Microsoft Office products (Outlook, PowerPoint, Excel and Word)
• PDF files
• Excellent investigational, analytical, organizational and critical thinking skills
• Detail oriented with analytic perspective
• Knowledge of criteria used to review for medical necessity (InterQual)
• Active Ohio State Registered Burse license
• California Registered Nurse (RN) preferred