Skip to content

Utilization Review Nurse Resume Examples

5/5 - 1 Reviews

Writing a resume for a Utilization Review Nurse position requires a unique set of skills and qualifications. With the increasing demand for experienced nurses, it is important for job seekers to ensure their resumes are up-to-date and specifically tailored to the Utilization Review Nurse role. This guide will help you craft a resume that showcases your experience, skills and qualifications and will help you stand out from other applicants. We’ll provide you with example resumes, best practices and tips to help you write a resume that will help you land the Utilization Review Nurse job you’re aiming for.

If you didn’t find what you were looking for, be sure to check out our complete library of resume examples.


Start building your dream career today! 

Create your professional resume in just 5 minutes with our easy-to-use resume builder!

Utilization Review Nurse Resume Examples

John Doe

Utilization Review Nurse

123 Main Street | Anytown, USA 99999 | Phone: (123) 456-7890 | Email:

Motivated and knowledgeable Utilization Review Nurse with 8+ years of experience in managing, evaluating, and coordinating patient care plans. Adept at developing and assessing utilization criteria to help ensure cost- effective patient care is delivered. Focused on providing quality patient care that exceeds patient and provider expectations.

Core Skills:

  • Utilization management
  • Clinical evaluation
  • Quality of care
  • Care coordination
  • Regulations compliance
  • Documentation and records management
  • Patient assessment
  • Problem solving
  • Time management

Professional Experience:
Utilization Review Nurse
Wellhealth Medical Group, Los Angeles, CA
August 2018 – Present

  • Review and assess medical records and patient care plans to ensure accurate and cost- effective care delivery
  • Develop and implement utilization criteria according to established guidelines
  • Assess quality of care received by patients and ensure high standards are met
  • Ensure appropriate second- level review is completed in order to improve quality of care
  • Monitor and evaluate patient care plans and patient outcomes
  • Coordinate care with other providers
  • Oversee the utilization review process to ensure accuracy
  • Review and update patient profiles when necessary

Utilization Review Nurse
St. Mary’s Hospital, Los Angeles, CA
March 2015 – August 2018

  • Facilitated and implemented utilization review plans for patients
  • Provided clinical evaluation and care coordination for patients
  • Monitored patient outcomes post- discharge to ensure quality of care
  • Ensured compliance with regulations and guidelines
  • Developed and maintained accurate documentation and records
  • Conducted patient assessments to ensure patient needs were met
  • Provided education and counseling to patients to reinforce care plans
  • Used problem- solving skills to resolve patient issues
  • Managed time efficiently to complete

Create My Resume

Build a professional resume in just minutes for free.

Utilization Review Nurse Resume with No Experience

Recent graduate with a Bachelor of Science in Nursing, eager to use my research and organizational skills to contribute to the Utilization Review field in a meaningful way.


  • Knowledgeable in medical terminology
  • Excellent interpersonal and communication skills
  • Strong research and organizational skills
  • Proficient in Microsoft Office Suite
  • Team- oriented attitude


  • Assessment of utilization review needs and development of appropriate plans
  • Documentation of utilization review processes and outcomes
  • Monitoring of utilization review activities and outcomes
  • Analysis of usage patterns to help identify opportunities for appropriate utilization of healthcare services
  • Collaboration with healthcare providers and staff to ensure efficient and effective utilization of healthcare services

0 Years



Utilization Review Nurse Resume with 2 Years of Experience

Dynamic and highly- skilled Utilization Review Nurse with 2 years of experience in providing health care services to a wide range of individuals. Proven track record of efficiently assessing patients’ eligibility for coverage and developing treatment strategies that are cost- effective, while meeting the highest standards of quality care. Possesses excellent communication skills, with a focus on building strong and meaningful relationships with patients, staff and providers.

Core Skills

  • Utilization review
  • Assessment of eligibility
  • Health care services
  • Patient care
  • Cost- effectiveness
  • Quality assurance
  • Interpersonal skills
  • Documentation


  • Conduct utilization reviews for patients to ensure that appropriate care is provided and all coverage criteria is met.
  • Identify alternative treatment methods to reduce the financial burden of care on the patient.
  • Monitor patient care to ensure that the highest standards of quality are met.
  • Analyze medical records for accuracy and completeness.
  • Provide clinical information and support to office staff, providers, and other stakeholders.
  • Assist with the development of strategies to improve the quality of care.
  • Create and maintain patient profiles to ensure accurate data is on file.
  • Ensure that all documentation is accurate, complete and in compliance with standards.

2+ Years



Utilization Review Nurse Resume with 5 Years of Experience

Highly capable and diligent Utilization Review Nurse with 5+ years of experience in patient assessment, discharge planning, and case management. Proven ability to develop comprehensive care plans to maximize patient health outcomes and efficiency of care delivery. Experience in collaborating with physicians, caregivers, and other healthcare professionals to ensure appropriate utilization of services and resources. Excellent communication and organizational skills leading to successful navigation throughout the healthcare system.

Core Skills

  • Patient Assessment
  • Discharge Planning
  • Case Management
  • Care Plan Development
  • Utilization Reviews
  • Collaboration
  • Communication
  • Organization
  • Medical Record Review


  • Conducted detailed assessments of patient medical needs, identifying appropriate care plans, services, and resources for discharge or continued care
  • Supervised utilization reviews for inpatient and outpatient services and determined authorization for payment
  • Participated in cases involving third- party payers, including Medicaid and private insurance, to ensure compliance with regulations
  • Collaborated with physicians, other healthcare professionals, and patient family to develop patient care plans
  • Communicated with insurance companies to obtain authorization for treatments and services
  • Reviewed medical records to determine utilization of services and to monitor for quality of care
  • Served as a liaison between the patient and healthcare team to ensure quality of care and best possible outcomes

5+ Years



Utilization Review Nurse Resume with 7 Years of Experience

Seasoned Utilization Review Nurse with 7 years of experience delivering quality patient care in acute care, long- term care and managed care settings. Highly adept in coordinating and implementing utilization review plans, training and mentoring staff, and ensuring compliance with applicable standards and regulations. Demonstrated expertise in assessing and interpreting medical information, cost- effective utilization of resources, and developing and implementing quality improvement initiatives.

Core Skills:

  • Utilization Review
  • Quality Assurance
  • Collaborative Care
  • Regulatory Compliance
  • Data Analysis
  • Team Leadership
  • Interdisciplinary Management


  • Coordinate and implement utilization review plans in line with organizational standards and regulations.
  • Review and analyze clinical data for medical necessity and cost- effectiveness of treatments and medications.
  • Provide timely and accurate information to healthcare professionals regarding utilization standards, quality and data management.
  • Monitor staff performance and provide guidance and training to ensure compliance with utilization review plans.
  • Utilize quality assurance and data collection methods to evaluate and document utilization and cost trends.
  • Facilitate interdisciplinary meetings and coordinate education programs to promote cost- effective utilization of care.
  • Educate and mentor staff on utilization review processes and data analysis.

7+ Years



Utilization Review Nurse Resume with 10 Years of Experience

Committed Utilization Review Nurse with 10+ Years of experience providing comprehensive health care services for patients in an inpatient and outpatient setting. Adept at coordinating, directing and monitoring the utilization of health care resources. Skilled at analyzing care documentation, determining appropriateness of services, and providing the necessary resources. Strong background in working with health insurance and managed care organizations, performing quality assurance reviews and auditing to increase patient satisfaction.

Core Skills:

  • Utilization Management
  • Quality Assurance
  • Data Entry
  • Health Insurance
  • Patient Documentation
  • Medical Necessity
  • Utilization Audit
  • Resource Utilization


  • Reviewed and assessed medical necessity of services and submitted concurrent reviews to insurance companies
  • Performed utilization and case management functions in accordance with state and federal regulations
  • Evaluated patient medical records for accuracy and completeness and recommended modifications for optimal care
  • Established and maintained communication with health care providers, managed care organization and payers
  • Provided consultation on utilization management issues to interdisciplinary team
  • Monitored and tracked utilization data and trends, and implemented strategies to reduce utilization and cost
  • Generated reports of clinical reviews and utilization activities to management team.

10+ Years

Senior Manager


Utilization Review Nurse Resume with 15 Years of Experience

Utilization Review Nurse with 15 years of experience in reviewing medical records, assessing medical necessity and determining coverage. Possesses an in- depth knowledge of medical coding, insurance policies and procedures, and regulatory requirements. Passionate about providing patients with the best quality care in the most cost- effective manner.

Core Skills:

  • Knowledgeable in utilization review standards, regulations, and procedures
  • Proficient in medical coding and insurance policies
  • Skilled in providing patient care with cost- effectiveness
  • Excellent in problem- solving and decision- making
  • Ability to multi- task and prioritize workload


  • Reviewed and assessed medical records to determine coverage and medical necessity
  • Applied medical coding and understanding of insurance policies to determine coverage eligibility
  • Evaluated treatment options for cost- effectiveness and appropriateness
  • Developed plans of care and appropriate authorization requirements
  • Established appropriate discharge planning and post- discharge care
  • Monitored and audited utilization of services to ensure compliance
  • Participated in Utilization Review committees to assess utilization trends
  • Provided education to staff regarding utilization review policies and procedures

15+ Years



In addition to this, be sure to check out our resume templates, resume formatscover letter examplesjob description, and career advice pages for more helpful tips and advice.

What should be included in a Utilization Review Nurse resume?

Writing a resume as a utilization review nurse can be daunting, as there are so many skills and qualifications you must highlight. However, it doesn’t have to be a challenge. Here are some tips and items to include to ensure your resume is comprehensive and effective:

  • Education: A utilization review nurse should include information about their educational background, including the name of the school they attended, the degree they earned and any relevant certifications they possess.
  • Experience: List all the previous positions you have held as a utilization review nurse, including the name of the organization, the duration of employment, and your job title.
  • Skills: Highlight the skills and qualifications that make you a great utilization review nurse, such as knowledge of health insurance laws, strong organizational abilities, and excellent communication and interpersonal skills.
  • Professional Affiliations: Make sure to include any professional memberships or affiliations you have, such as membership in the American Association of Utilization Review Nurses (AURN).
  • Awards and Honors: If you have been recognized and honored for your work as a utilization review nurse, make sure to include that information.

These are just some of the items that should be included in a utilization review nurse resume. By following these tips, you can ensure that your qualifications and experience are highlighted in the most effective way.

What is a good summary for a Utilization Review Nurse resume?

A Utilization Review Nurse resume should focus on their experience and accomplishments in utilization review, medical case management, and discharge planning. It should emphasize their ability to facilitate communication between patients, their families, and healthcare providers. They should highlight their ability to evaluate patient care requests thoroughly and accurately, their understanding of state and federal regulations, and their aptitude for communicating with insurance companies. The resume should also detail their familiarity with medical terminology and coding, as well as their outstanding organizational and multitasking skills.

What is a good objective for a Utilization Review Nurse resume?

A Utilization Review Nurse (URN) is a registered nurse who is responsible for ensuring the quality and cost-effectiveness of patient care. The URN performs assessments of patient care and utilization of health care services to ensure they are appropriate, necessary and cost-effective. A good objective for a URN resume should reflect an understanding of the role and its importance in the health care system.

  • Demonstrate extensive experience in the field of utilization review, including expertise in assessing patient care and utilization of health care services.
  • Possess strong knowledge of the principles and regulations of utilization review.
  • Utilize analytical and problem-solving skills to ensure the quality, cost-effectiveness and appropriateness of patient care.
  • Ability to collaborate and communicate effectively with other health care professionals, patients, and other stakeholders.
  • Commitment to providing excellent patient care and delivering quality outcomes.
  • Dedication to upholding ethical principles and professional standards in the health care system.

How do you list Utilization Review Nurse skills on a resume?

When you are creating a resume for a Utilization Review Nurse position, it is important to ensure that you include the skills and qualifications that will show employers you have the expertise they need. Utilization Review Nurses are responsible for ensuring that patients receive the care they need without over-utilizing services or running up excessive costs. To showcase your qualifications for a Utilization Review Nurse role, include the following skills on your resume:

  • Knowledge of health care plans, benefits and utilization review: Utilization Review Nurses must have an understanding of the various health care plans available and how they impact patient care and cost.
  • Ability to analyze and interpret medical records: Utilization Review Nurses must be able to review medical records, assess patient care plans, and provide recommendations to ensure the most cost-effectively care options are selected.
  • Experience with medical coding and billing: Utilization Review Nurses must be familiar with medical coding and billing practices to ensure that patients are billed correctly and given the right care at the right time.
  • Ability to communicate in a professional manner: Utilization Review Nurses need to be able to communicate with a variety of professionals, including doctors, nurses, and office staff, in a professional manner.
  • Attention to detail: Utilization Review Nurses must be able to review and follow up on patient records in an accurate and timely manner.
  • Problem solving skills: Utilization Review Nurses must be able to identify and address any issues that arise in the care of patients.

By highlighting these skills on your resume, you can showcase your qualifications for a Utilization Review Nurse role and demonstrate to potential employers that you are the right person for the job.

What skills should I put on my resume for Utilization Review Nurse ?

As exciting as the field of Utilization Review Nursing may be, you know that you need to put together an impressive resume in order to stand out from the competition and get the job you really want. When it comes to preparing your resume, it is important to focus on the skills that will be the most beneficial for this position. Here are some of the skills you should consider adding to your resume for a Utilization Review Nurse position:

  • Knowledge of Medical Terminology: A Utilization Review Nurse must be familiar with a wide range of medical terms and be able to accurately interpret and apply them.
  • Interpersonal Skills: This position requires strong interpersonal skills in order to effectively communicate with patients and other healthcare staff.
  • Computer Skills: Being able to utilize computer programs and other technology for data entry, gathering information, and analyzing data is a must for this role.
  • Organization Skills: Utilization Review Nurses must be organized in order to keep track of patient information and medical records and ensure that all data is properly documented.
  • Attention to Detail: Being able to review and analyze patient data and medical records while maintaining accuracy is essential.
  • Critical Thinking: Utilization Review Nurses must be able to think critically and make decisions quickly and efficiently.
  • Problem Solving: The ability to assess and solve problems related to patient care is essential.

By highlighting the skills listed above on your resume, you will be able to demonstrate your qualifications for a Utilization Review Nurse position and stand out from the competition. Good luck!

Key takeaways for an Utilization Review Nurse resume

When it comes to crafting a strong resume for an Utilization Review Nurse, there are several key takeaways to keep in mind. A clear understanding of the responsibilities of a Utilization Review Nurse, as well as their role in the healthcare system, is essential if you want to create an effective resume that will get you noticed. Here are some key takeaways to consider when preparing a resume for an Utilization Review Nurse.

  1. Demonstrate your knowledge: Utilization Review Nurses have an important role in the healthcare system, so it is important that your resume displays your knowledge of the profession. Include information about your specific experience in a utilization review setting, as well as your familiarity with the relevant regulations and standards.
  2. Highlight your experience: A successful Utilization Review Nurse should possess a number of skills, so be sure to highlight your experience with them. For example, list any previous experience with coding, data analysis, and Medicare and Medicaid guidelines.
  3. Showcase your communication skills: A Utilization Review Nurse must be able to effectively communicate with other healthcare professionals, so make sure your resume features your communication skills. Include any prior experience with customer service, as well as any examples of successful collaborations you have participated in.
  4. Show your problem-solving abilities: Utilization Review Nurses are often called upon to solve complex problems, so use your resume to showcase your problem-solving abilities. Include examples of times you have identified cost-savings opportunities or streamlined processes.
  5. Describe your certifications: Utilization Review Nurses must be certified in order to practice, so make sure your resume lists any certifications you have obtained. Additionally, list any professional organizations or associations you belong to, as this displays your commitment to the profession.

By using these key takeaways when crafting your resume, you can create a comprehensive and effective document that will demonstrate

Let us help you build
your Resume!

Make your resume more organized and attractive with our Resume Builder

Resume template