Medical Manager

TERRIE REDING

**** *. ******** ****. ***. #**** Cedar Park, Texas 78613

Cell Phone 806-***-**** ********@***.***

A results-driven, dedicated professional with solid experience in the medical & managed care field

as well as “branded” entertainment & promotions field

SUMMARY OF QUALIFICATIONS

Over ten years of experience working in Pre-Authorization & Utilization Review, On-site and

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Telephonic Case Management, Home Health, Kidney Dialysis, Med-Surg, Hospice, Oncology, OR,

and Rehabilitation

Extensive experience performing clinical reviews for medical necessity, assessment, planning &

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implementation of care plans, medication administration and overall total patient care

Solid knowledge of managed care field, TWCC, worker’s compensation laws, disease processes,

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accepted diagnosis, and treatment and return to work plans

Possess TX RN License #562869

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Well-organized, self-motivated individual with ability to rapidly learn new tasks.

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Track record for consistently meeting goals and delivering a high level of job performance.

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Proven ability to build strong customer/client relationships.

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PROFESSIONAL EXPERIENCE

Teri Hart Productions – President Austin, Texas 1990– Present

Providing quality professional Branded Musical Entertainment and Promotional Services for

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Corporations, Clubs, Resorts, and the Military Sector. (Utilizing the stage name of Teri Hart)

Creation and development of marketing and promotional events for manufacturers, utilizing original

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musical compositions to design targeted promotional packaging for the trucking industry.

Collaborated with CEO’s and National Sales Managers to develop successful marketing &

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promotional campaigns at conventions, trade shows, and public events.

HNC Insurance Solutions (Utilization/Pre-Authorization) Dallas, Texas J une 1998- July 2000

• Performed reviews of patient clinical records for medical necessity in order to approve pre-

authorization for a variety of treatments and procedures requested by the provider.

• Entered medical data into computer, issued approval or denials for requested treatment, and followed

up with concurrent reviews if necessary.

• All requests were received either telephonically or by fax, and when in question as to the medical

necessity, were handed off to the in-house physician advisor for ultimate denial or approval.

Providers were contacted in accordance with guidelines regarding the entire process.

Firstat Nursing Registry (Total Patient Care) Phoenix, AZ March 1995- November 1996

(no longer in business)

Hospital & nursing home staffing, private duty & hospice

• Performed total patient care duties including chart review of history, diagnosis, physician orders, labs,

radiology, etc.

• Conducted admissions & assessments, developed care plans and nursing diagnosis, administered

medications according to MAR, performed dressing changes, and other prescribed treatments or

procedures according to protocol. Documented all actions & responses, and collaborated with other

members of the health team to ensure overall plan was implemented and goals were met.

Concentra (On Site & Telephonic Case Manager) Abilene Texas, and Dallas, Texas 1992-1994

April 1997-April 1998

Acted as a liaison between the injured worker, physician, and insurance company or third party

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administrator to coordinate a timely recovery and rehabilitation process. Met with the worker and

physician, and other specialists to obtain information specific to the injury and treatment, and monitor

patient compliance, and when appropriate negotiated for return to light duty, or full work release.

Determined through counsel with physician if work restrictions were necessary and if so, as to what

level.

BMA Kidney Dialysis Center (Total Patient Care) Lubbock, Texas

1991-1992

• Performed patient assessments, reviewed orders, initiated dialysis treatment and monitored patient for

duration of the treatment, Documented all actions and responses including medication administration,

patient vitals, pre and post treatment weight, and lab studies.

Methodist Hospital Operating Room, Med Surg & Oncology (Total Patient Care) Lubbock, Texas

1988-1991

Performed all duties of circulating nurse including pre-operative, peri-operative, and post-operative tasks.

Reviewed charts, assembled all necessary equipment, instruments, drapes and other supplies for the

operative procedure. Conducted sponge and sharps counts, positioned patient with appropriate items to

ensure maximum safety throughout the operation, and worked alongside all other medical professionals

involved in the specific cases.

Performed Total Patient Care Duties in both the med surg and oncology areas.

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EDUCATION

Applied Sciences Associates Degree, New Mexico Jr. College, Hobbs, New Mexico, 1990

Texas RN License # 562869

Note: Concentra sold the managed care division of the company to Coventry in 2007

BMA was sold to Fresenius Medical Care

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