Build a Utilization Review Nurse Resume Payers Take Seriously
Utilization review nurse resume examples plus InterQual and MCG keywords, sample bullets, and a writing guide for medical necessity and appeals work.
Example Utilization Review Nurse summary
Registered nurse with eleven years of clinical practice and four years of utilization review for a regional health plan. Applies InterQual acute criteria to inpatient admission and continued-stay decisions, prepares peer-to-peer referrals, and writes first-level appeal responses grounded in plan policy. Seeking a remote utilization review role covering multi-state commercial and Medicare Advantage membership.
Skills to list on a Utilization Review Nurse resume
- InterQual criteria
- MCG guidelines
- Concurrent review
- Prior authorization
- Medical necessity determination
- Appeals and denials
- Discharge planning
- Case management
- Clinical documentation review
- Epic
- Cerner
- CMS coverage criteria
- Length of stay analysis
- Peer-to-peer referral
- Managed care
What actually gets this resume read
- Name the criteria set you apply, InterQual or MCG, in the summary and again inside at least one experience bullet.
- State your daily review volume and the review type, admission, concurrent or retrospective, so a manager can size your throughput.
- Show the appeals side of the job separately from review, because many postings weight written appeal work heavily.
- List the payer systems and portals you have worked in alongside the hospital chart you read from, such as Epic or Cerner.
- Keep your bedside years visible with the unit and patient population; payers hire the clinical judgment, not just the desk skills.
- Mirror the posting language on setting, whether that is health plan, acute hospital, workers compensation or managed care.
- Add the states your compact or single-state license covers, since remote review roles are filtered on license reach.