Most of the healthcare facilities hire a UM Coordinator for controlling service-improvement programs. A successful UM Coordinator Resume mentions the following core duties and responsibilities – monitoring the health and status of residents of patients within the facility to ensure that they are being cared for properly; training employees within the hospital to develop the right care plan, participating in inspections of the health care facility, making recommendations on how the nursing service department can be improved, and monitoring changes in federal and state health care laws and ensuring compliance.
Utilization management is crucial for any facility, and hence the professional coordinating this segment should possess certain complex skillset in the following forms – project management skills, the ability to make presentations, robust assessment, analytical and computer skills. This role requires a bachelor’s degree in social work, psychology, counseling, or a closely related field. In many cases, an associate’s degree in nursing and licenses are required.
Objective : Dedicated Utilization Management Coordinator with 2 years of hands-on experience in streamlining patient care processes and optimizing resource utilization. Skilled in managing referrals, verifying benefits, and ensuring compliance with healthcare regulations. Committed to enhancing patient outcomes through effective communication and collaboration with healthcare teams.
Skills : Healthcare Documentation, Data Analysis And Reporting, Benefits Verification, Authorization Management
Description :
Managed patient referrals and authorizations, ensuring timely processing within established deadlines.
Collaborated with multidisciplinary teams to address patient needs and improve service delivery.
Oversaw adherence to healthcare regulations, maintaining compliance with UM policies.
Assisted in the development and refinement of departmental procedures to enhance workflow efficiency.
Provided training and support to new staff on UM processes and best practices.
Analyzed data to identify trends and recommend improvements to patient care protocols.
Facilitated communication between patients, providers, and insurance companies to resolve issues swiftly.
Experience
0-2 Years
Level
Entry Level
Education
BSN
Utilization Management Coordinator Resume
Objective : Dynamic Utilization Management Coordinator with 5 years of experience in optimizing patient care and resource allocation. Proven ability to manage referrals, verify benefits, and ensure compliance with healthcare regulations. Passionate about improving patient outcomes through effective collaboration and communication with multidisciplinary teams.
Skills : Data Analysis, Communication Skills, Problem Solving, Team Collaboration, Conflict Resolution
Description :
Managed patient referrals and authorizations, ensuring timely processing and compliance with regulations.
Utilized electronic medical records for accurate documentation and data retrieval.
Communicated effectively with healthcare providers to resolve referral inquiries.
Reviewed medical documentation to determine eligibility for services and benefits.
Analyzed patient data to identify trends and improve resource allocation.
Maintained up-to-date knowledge of ICD-10 codes and medical terminology.
Participated in interdisciplinary team meetings to discuss patient care strategies.
Experience
2-5 Years
Level
Junior
Education
BSN
UM Coordinator Resume
Headline : Innovative Utilization Management Coordinator with 7 years of expertise in enhancing healthcare delivery and resource management. Proficient in overseeing authorization processes, ensuring compliance, and collaborating with clinical teams to optimize patient outcomes. Focused on implementing effective strategies that streamline operations and improve service quality.
Skills : Patient Records Management, Training And Development, Networking Skills, Report Writing, Project Management, Public Speaking
Description :
Created and monitored evaluations in MedHub to ensure compliance and quality standards.
Distributed evaluations and tracked completion rates for continuous improvements.
Tracked and reported conference attendance to enhance training opportunities.
Developed and disseminated orientation materials for new team members.
Generated morbidity and mortality reports for quality assurance initiatives.
Monitored missing case log reports to address gaps in patient care.
Acted as a liaison between the Program Director and residents, ensuring effective communication.
Experience
5-7 Years
Level
Senior
Education
BSN
Utilization Management Coordinator Resume
Summary : Dedicated UM Coordinator with over 5 years of experience in managing utilization review processes. Proven track record in ensuring compliance with healthcare regulations and optimizing patient care. Skilled in data analysis, case management, and interdisciplinary collaboration to enhance service delivery and reduce costs. Strong communicator with a focus on improving patient outcomes and operational efficiency.
Skills : Microsoft Office Suite, Care Coordination, Patient Advocacy, Case Management, Health Education, Crisis Intervention
Description :
Applied policies and procedures effectively to ensure compliance with healthcare regulations.
Collaborated with healthcare professionals to assess and manage patient care needs.
Maintained confidentiality of Protected Health Information (PHI) in accordance with legal standards.
Documented activities accurately in automated systems to meet established performance goals.
Coordinated with Registered Nurses for case reviews and care planning.
Processed prior authorizations efficiently, enhancing service delivery.
Exceeded performance expectations while working remotely, demonstrating adaptability and productivity.
Experience
7-10 Years
Level
Management
Education
BSN
UM Coordinator Resume
Summary : Accomplished Utilization Management Coordinator with a decade of experience in enhancing healthcare operations and patient care processes. Expert in managing authorizations, assessing compliance, and collaborating with diverse teams to drive quality improvements. Dedicated to leveraging data-driven insights to optimize resource allocation and ensure superior patient outcomes.
Skills : Healthcare Software Proficiency, Regulatory Compliance Management, Documentation Skills, Time Management, Multitasking, Cultural Competence
Description :
Processed referral authorizations and requests using the Xpress system, ensuring accuracy and efficiency.
Verified eligibility and resolved benefit issues, collaborating with provider offices to enhance service delivery.
Authorized requests within established guidelines, maintaining compliance with healthcare regulations.
Managed provider and member inquiries regarding utilization management and case management processes.
Drafted and dispatched denial letters to providers and members with clear explanations.
Distributed referral notifications to healthcare providers and health plans promptly.
Maintained updated inpatient lists for physicians and management, tracking patient discharge and hospice assignments.
Experience
10+ Years
Level
Executive
Education
BSHA
Junior UM Coordinator Resume
Objective : Healthcare professional with 5 years of experience in utilization management, adept at streamlining patient care processes and ensuring compliance with regulations. Expertise in managing referrals and authorizations, dedicated to enhancing patient outcomes through effective collaboration with clinical teams. Committed to leveraging analytical skills for improved resource allocation and operational efficiency.
Conducted daily eligibility and benefit checks using internal systems to ensure accurate patient data.
Processed referrals and authorizations in MHC and Corecon, maintaining compliance with established guidelines.
Generated and approved authorizations based on business rules, ensuring timely service delivery.
Collaborated with Medical Directors to review authorization outcomes for adherence to compliance standards.
Requested and analyzed LOA039s with the contracting department as needed.
Participated in GME Program Administrator Education Series to enhance knowledge of current practices.
Provided exceptional support to residents and fellows, addressing program inquiries effectively.
Experience
2-5 Years
Level
Junior
Education
BSHA
UM Coordinator Resume
Objective : Results-oriented Utilization Management Coordinator with 2 years of experience in enhancing patient care through efficient referral management and benefit verification. Proficient in ensuring compliance with healthcare regulations and optimizing resource allocation. Driven to improve patient outcomes by fostering collaboration within multidisciplinary teams.
Skills : Patient Care Coordination, Budget Management, Policy Implementation, Clinical Knowledge, Referral Management, Team Leadership
Description :
Calculated daily staffing needs for departments, optimizing resource allocation.
Coordinated personnel replacements for earned time off and other absences, ensuring coverage.
Processed all time-off requests, adhering to department guidelines and staffing needs.
Ensured compliance with union agreements within the Staffing and Payroll Office.
Assisted in generating work hour compliance reports to enhance operational efficiency.
Arranged travel for residents and fellows, streamlining logistics.
Monitored adherence to departmental policies and procedures.
Experience
0-2 Years
Level
Fresher
Education
B.S.H.A.
Senior UM Coordinator Resume
Headline : Accomplished Senior Utilization Management Coordinator with 7 years of experience in optimizing patient care pathways and resource management. Adept at leading authorization processes, ensuring regulatory compliance, and collaborating with clinical teams to enhance patient outcomes. Committed to driving operational efficiency through strategic initiatives and data-driven decision-making.
Managed and tracked Senior Expedited Organizational Determination Requests, ensuring timely processing and compliance with health plan protocols.
Generated monthly quality assurance reports in alignment with Medicare guidelines, enhancing operational transparency.
Leveraged strong communication skills to collaborate effectively with healthcare providers, including physicians and nursing staff.
Applied in-depth knowledge of referral guidelines to optimize patient transitions and care continuity.
Oversaw outpatient member management to ensure appropriate care levels, reducing inpatient re-admissions.
Coordinated authorizations with contracted providers, facilitating efficient service delivery.
Maintained comprehensive documentation of sick leave accounts to support departmental reporting needs.
Experience
5-7 Years
Level
Senior
Education
BSN
UM Coordinator Resume
Objective : Accomplished Utilization Management Coordinator with 5 years of experience in enhancing patient care and optimizing resource utilization. Expert in managing authorizations, ensuring regulatory compliance, and fostering collaboration with multidisciplinary teams to improve patient outcomes. Committed to leveraging data-driven strategies for efficient healthcare delivery and superior service quality.
Designed and implemented a comprehensive utilization management system, adhering to best practices in healthcare delivery.
Resolved complex issues related to patient care and resource management, ensuring compliance with healthcare policies.
Monitored utilization trends and initiated changes to improve system efficiency and patient satisfaction.
Developed training programs for staff on utilization management protocols.
Provided ongoing support to healthcare providers regarding referral processes and authorizations.
Conducted data analysis to identify opportunities for service improvement and cost reduction.
Collaborated with interdisciplinary teams to enhance patient care strategies and operational workflows.
Experience
2-5 Years
Level
Junior
Education
BSN
UM Coordinator Resume
Summary : Results-focused UM Coordinator with a decade of experience in enhancing patient care and optimizing resource management. Expert in navigating complex healthcare regulations, ensuring compliance, and leading interdisciplinary teams. Adept at utilizing data analytics to drive decisions that improve patient outcomes and operational efficiency.
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