Deana Rindy

*** ******** ***** ( La Conner, Washington 98257 ( abvla6@r.postjobfree.com (

360-***-****

Medical Case Management

Analytical, accomplished professional offering 15+ years' success ensuring

the provision of exceptional patient care in diverse healthcare settings.

Detail-oriented and well-organized with proven aptitude for reviewing and

analyzing medical records, leveraging experience as registered nurse in

direct patient care to properly align resources and address documentation

inaccuracies and deficiencies. Excellent written and oral communication

talents; effectively coordinate with fellow medical professionals to

promote seamless patient care. Clearly convey treatment and recovery plans

to patients and their families, providing education to expedite

recuperation.

Core Competencies

Preauthorization & Concurrent Documentation & Reporting

Review Medical Record Auditing

Utilization Management Team Building & Leadership

Discharge Planning Patient Care & Communication

Cross-functional Collaboration

Career Experience

The Regence Group, Burlington, WA

Utilization Management Nurse, 12/2011 - 4/2013

Conducted preauthorization reviews for clinical services, thoroughly

evaluating patient clinical information for preauthorization requests to

verify medical necessity. Applied clinical expertise and sound judgment to

ensure compliance with medical policy, medical necessity guidelines, and

accepted standards of care. Maintained open lines of communication with

colleagues, providers. Provided new hire orientation, educating on medical

policies and computer systems.

Key Contributions:

. Consistently met and exceeded aggressive production metrics.

. Pursued education opportunities to expand knowledge, specifically

orthopedic reviews. Recognized as "spine expert" within the department

and shared knowledge with colleagues, promoting improvement of

performance reviews.

. Compiled and distributed training materials, including step-by-step

instructions for review and determination process as well as a more

user-friendly guide for reviewing certain medical policies.

. Proactively initiated in-service programs prior to hiring of a

designated trainer.

St. David's Medical Center, Austin, TX

Clinical Documentation Liaison, 11/2009 - 10/2011

Performed concurrent review of patient medical records to identify

opportunities for enhancing quality and accuracy of patient data, improving

mortality statistics and driving increases in reimbursement. Verified

completeness of documentation to correctly reflect patient conditions and

resource usage. Communicated with Physicians, Registered Nurses, and

hospital staff to address documentation issues. Compiled reports on program

effectiveness.

Key Contribution:

. Maintained excellent record of accuracy, promptly and effectively

resolving issues.

Island Hospital, Anacortes, WA

Case Manager / Screening Colonoscopy Coordinator / Preoperative Education

Nurse, 8/2001 - 8/2009

Coordinated with patients on discharge planning, maintaining focus on

ensuring timely and successful recovery post discharge. Communicated with

patients, families, and medical staff on all aspects of discharge. Provided

patient consultations on surgery preparation and post-operative care

requirements. Screened colonoscopy referrals and managed colonoscopy

scheduling, instructing patients on procedure preparation. Performed

utilization review, analyzing clinical information for medical necessity

and coordinating with insurance companies on reimbursement.

Key Contributions:

. Supported operations by assisting with the development of pneumonia

vaccine protocol.

. Improved existing pre- and post-op curriculum.

. Successfully reduced wait time for colonoscopy referrals from two years

to one month.

Texas Peer Assistance Program for Nurses, Austin, TX

Case Manager, 4/2001 - 7/2001

Provided education and support to nurses requiring treatment for chemical

dependency or mental illness. Monitored progress, tracking and controlling

nurse participant programs. Served as referral source for treatment

providers and program advocates. Organized and maintained patient and

provider documentation.

Seton Shoal Creek Hospital, Austin, TX St. David's Pavilion, Austin, TX

Admission Coordinator / Care Manager, 8/1999 - 7/2001

Conducted intake interviews to evaluate necessity of psychiatric services,

to include providing resources and referrals to patients. Collaborated with

Physicians, Discharge Planners, medical staff, and outside professionals on

treatment planning. Coordinated care provisioning. Communicated with

insurance companies on medical necessity and reimbursement. Reviewed

psychiatric and medical records.

Key Contribution:

. Hand-selected for position by management due to proven skills across

psychiatric nursing, treatment planning, and document management.

St. David's Pavilion, Austin, TX

Nursing Supervisor, 9/1996 - 3/1998

Managed 10-member nursing team while providing direct patient care for as

many as 30 psychiatric patients. Reviewed patient records in performing

clinical assessments; leveraged therapeutic communication while working

directly with patients. Managed workflow scheduling to ensure adequate

resources. Directed staffing efforts; provided new employees with

orientation and performance appraisals, assessing patient care and intake

process.

Key Contribution:

. Rapidly promoted from patient care to leadership role as a result of

outstanding job performance.

Education and Credentials

Associate Degree in Nursing / Registered Nurse

Austin Community College - Austin, TX

Licensed Vocational Nursing Program

Austin Community College - Austin, TX

Technical Skills

Windows, MS Office Suite (Word, Outlook), Meditech, 3M Coding Software,

Trizetto / Clinical Care Advance, Facets

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