TERESITA REYES, RN

***** ****** *** ****** *****, CA, 91326

(H) 818-***-**** (C) 818-***-**** ac190p@r.postjobfree.com OBJECTIVE

To obtain a position as a RN Care Manager and secure myself in a field which has been my expertise more than three decades. A company who will allow me to put forth work and help further the company with my wide array of extensive experience and expertise in the Medical Field.

SKILLS PROFILE

• Hands-on experience in working on medical claims

• Operational knowledge of computer systems and Microsoft applications

• Immense ability to work independently and prioritize work

• Exceptional ability to analyze strength and weakness of all issues PROFESSIONAL EXPERIENCE

Concurrent Nurse Reviewer – Health Net, Inc.

10/16- 01/17 Woodland Hills, CA

- Reviews inpatient concurrent claims

- Knowledge of InterQual

Pre-Authorization Nurse –Health Care Partners

02/15- 05/16 Chatsworth, CA

- Work as prior authorization Nurse Reviewer for HMO-UM/CM Medical Review Specialist II, Anthem, WellPoint

9/2003 01/15 Woodland Hills, CA

- Do Retrospective Reviews, Outpatient, Inpatient Claims, AIM Radiology Claims

- Refer cases to PCR for complex reviews

Case Manager, United Government Service – Cobalt Co. 2000 2003 Camarillo, CA

- Reviews Medicare Claims, Outpatient, SNF, Home Health, Hospice, PT, OT, ST & Psychiatry

Case Manager, Blue-Cross Anthem WellPoint

1996 2000 Woodland Hills, CA

- Medicare Review

- Claims Department/Onsite Audit Claims for Medicare

- Reviews Medicare Claims, Outpatient, SNF, Home Health, Hospice, PT, OT, & ST Medical /Surgical Nurse, Cedars Sinai Medical Center 1988 1995 Los Angeles, CA

- Worked as an RN from 1988 - 1995

- Units worked – Orthopedics, Dialysis, Renal, G.I., Oncology

- Home Health Nursing (1994-1995)

EDUCATION

Manila Doctors College of Nursing – Manila, Philippines

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