Utilization Manager Resume

Posted in Resume Samples for Manager

Melvin Robinson
706 Aviation Way
Pomona, CA 91766

Job Objective Seeking a position with company in which to exercise my experience and training as an Utilization Manager.

Highlights of Qualifications:

  • Huge experience in managing health care , managing clinical documents and developing and implementing various programs
  • Exceptional knowledge of methods and various techniques of health care
  • Huge knowledge of health plans and related processes
  • Outstanding ability to provide optimal service in multiple health care facility
  • Ability to work in coordination with medical staff
  • Skilled to work on computer and resolve problems
  • Remarkable oral and written communication skills
  • Proficient n understanding all components of health care
  • Familiarity in medical terminology and related contracts

Professional Experience:

Utilization Manager
Amerigroup, Pomona, CA
October 2008 – Present

  • Reviewed acute service at site and on telephone as well.
  • Planned pre admission of patients required and prepared post discharge care.
  • Managed work in accordance to guidelines provided to validate medical work.
  • Coordinated with manager and prepared census for various health care services.
  • Maintained quality services with maximum utilization of available resources.
  • Documented all policies in system according to time.
  • Monitored Quality Improvement Process carried by members.
  • Provided customer service to both internal and external customers.

Utilization Coordinator
AppleOne, Pomona, CA
August 2003 – September 2008

  • Reviewed all patient information and recorded details of patient illness and resources utilized for services.
  • Coordinated with physician and discharge staff and facilitated patient care and timely discharge.
  • Managed vendors and provided external parties necessary information of facility to obtain necessary certificates.
  • Assisted coding staff in documenting process such as patient condition, resource used and any medical emergency rendered.
  • Evaluated all medical records and performed quality monitoring on required documents.
  • Planned and assessed al patient discharge.

Utilization Lead
CVS Caremark, Pomona, CA
May 1998 – July 2003

  • Reviewed all contracts and ensured benefit eligibility and authorized inpatient admission.
  • Monitored cases and referred cases for clinical review and handled specialty care services.
  • Coordinated between internal departments and medical management.
  • Managed all queries by clients and assisted various in house departments.
  • Trained new employees and subordinate staff in various functions.
  • Evaluated all benefit programs for facility based treatment.


Bachelor’s Degree in Business
Wilmington College, Wilmington, OH

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