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Case reviewer skills for your resume and career

Updated January 8, 2025
3 min read
Below we've compiled a list of the most critical case reviewer skills. We ranked the top skills for case reviewers based on the percentage of resumes they appeared on. For example, 20.0% of case reviewer resumes contained background investigations as a skill. Continue reading to find out what skills a case reviewer needs to be successful in the workplace.

15 case reviewer skills for your resume and career

1. Background Investigations

Here's how case reviewers use background investigations:
  • Review federal background investigations to ensure quality and timeliness, communicate with Investigators to ensure case coverage is met.
  • Prepare requirements of security clearance background investigations for field investigators and direct them to acquire additional information as necessary.

2. Due Dates

Here's how case reviewers use due dates:
  • Monitored open cases to ensure completion by due date and to ensure case has been completed according to contract guidelines.
  • Monitored pending cases to ensure compliance with delivery due dates and track submission of investigative leads.

3. National Security

Here's how case reviewers use national security:
  • Highlight and examine observations surrounding potential threats to National Security for applicants of cleared positions with Federal agencies and government contractors.
  • Interpreted, adapted, and applied the overall national security guidelines to derogatory and complex issues.

4. Social Work

Here's how case reviewers use social work:
  • Prepared for case reviews by reviewing the case record, meeting with the assigned social worker and/or supervisor.
  • Reviewed 30-50 adoption/foster care case files daily for accurate and up-to-date reporting by social workers.

5. Foster Care

Here's how case reviewers use foster care:
  • Worked with the Department of Children and Families alongside a professional foster care reviewer.
  • Foster care and adoption records were reviewed at several county agencies.

6. Review Process

Here's how case reviewers use review process:
  • Demonstrated proficiency in communicating with other researchers, program managers, and subject-specific professionals to optimize application review processes.
  • Assigned higher levels of responsibility including training and instructing co-workers on appraisal review process.

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7. Medicaid

Here's how case reviewers use medicaid:
  • Redesign and standardize the process for Medicaid/Medicare clients to access lab services, thus increasing collaborations between allied non-profit organizations.
  • Conduct post-payment audits for NC Department of Medical Assistance/Program Integrity for behavioral health providers suspected of Medicaid fraud and abuse.

8. Medical Terminology

Here's how case reviewers use medical terminology:
  • Utilized strong working knowledge of medical terminology for treatments and procedures to identify abnormalities in claims.
  • Proofread medical documentation for accuracy in grammar, punctuation, medical terminology, and format.

9. Utilization Review

Another name for utilization review is utilization management. It is the process of ensuring that healthcare services are used in a suitable manner. Utilization review is a critical component of adding value to the health care system. Mostly, UR is carried out by healthcare insurance companies, but hospitals and other healthcare providers also perform the process. Utilization review has three types of assessment namely: concurrent, prospective, and retrospective.

Here's how case reviewers use utilization review:
  • Assisted with utilization review for the organization through appropriate communications with the physicians, ensuring proper documentation procedures were kept.
  • Performed admission and concurrent utilization reviews to identify medical necessity, level of care, and appropriateness of setting.

10. Medical Necessity

Here's how case reviewers use medical necessity:
  • Determine if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.
  • Collaborated with insurance case managers to provide medical necessity reviews for stay approvals.

11. Medical Documentation

Here's how case reviewers use medical documentation:
  • Applied clinical judgment in determining if medical documentation reflected standards of care.
  • Interpret and summarize medical documentation from nationwide providers.

12. Management System

A management system is a set of policies, processes, and procedures taken by an organization or a business to ensure it can fulfill its tasks and achieve its objectives. A management system makes sure that the company excels financially and improves the user experience. The management system also takes care of the worker's and employees' needs and manages their workload and oversees their performance. Apart from interior matters of the company, a management system also deals with exterior matters like legislations, tax matters, and law issues.

Here's how case reviewers use management system:
  • Submitted final reports of background security investigations on all contracts using secured case management systems.
  • Assisted in the development of an automated Case Management System, which allowed for timely case completion.

13. Quality Assurance Purposes

Here's how case reviewers use quality assurance purposes:
  • Review completed work for quality assurance purposes.

14. Quality Assurance Reviews

Here's how case reviewers use quality assurance reviews:
  • Performed supervisory reviews and quality assurance reviews to ensure investigations of cases met department standards for waiving and approving cases.
  • Conducted quality assurance reviews by soliciting feedback from references interviewed during the background investigation.

15. Milliman

Here's how case reviewers use milliman:
  • Conducted onsite admission assessments, and concurrent reviews on each member using Milliman criteria.
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List of case reviewer skills to add to your resume

Case reviewer skills

The most important skills for a case reviewer resume and required skills for a case reviewer to have include:

  • Background Investigations
  • Due Dates
  • National Security
  • Social Work
  • Foster Care
  • Review Process
  • Medicaid
  • Medical Terminology
  • Utilization Review
  • Medical Necessity
  • Medical Documentation
  • Management System
  • Quality Assurance Purposes
  • Quality Assurance Reviews
  • Milliman
  • OPM
  • Pips
  • Quality Standards
  • Medical Review
  • Computer Programs
  • HIPAA
  • CMS
  • Medical Care
  • Issue Resolution
  • Patient Education
  • Federal Government
  • Medical Services
  • ROI

Updated January 8, 2025

Zippia Research Team
Zippia Team

Editorial Staff

The Zippia Research Team has spent countless hours reviewing resumes, job postings, and government data to determine what goes into getting a job in each phase of life. Professional writers and data scientists comprise the Zippia Research Team.

Updated January 8, 2025

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