Kenya Love
CareCentrix
Tennessee,United States
1
Certification
21
years of professional experience
Licensed Practical Nurse with 19+ years of healthcare experience spanning utilization management, clinical review, case management, post-acute care coordination, and direct patient care. Experienced in analyzing complex clinical medical records, identifying clinical and documentation concerns, and evaluating care against evidence-based and regulatory standards. Developing a clear, defensible clinical rationale.
Demonstrated record of quality and compliance, including a 97% audit average and 100% audit performance. Experienced in identifying care gaps, recognizing barriers and potential quality concerns, escalating complex clinical issues, and collaborating across multidisciplinary teams.
Bringing a strong process improvement mindset with experience working to improve clinical workflows, mentoring colleagues, and supporting efficient, compliant clinical operations in remote healthcare environments.
Work History
PAC Nurse
2 Years 4 Months- Conduct comprehensive concurrent reviews of complex post-acute cases.
- Analyze documentation, treatment progression, functional status, discharge barriers, and medical necessity.
- Apply MCG, CMS, contractual, and clinical standards to support accurate, evidence-based utilization and care decisions.
- Identify potential clinical risk factors and gaps in care, documenting concerns requiring additional review or escalation.
- Serves as subject matter resource, mentoring colleagues, and providing guidance on complex clinical cases, workflows, and documentation.
Managed Care Coordinator
9 Months- Coordinated care and supported patient engagement through telephonic outreach.
- Ensured continuity of care following hospital discharge.
- Built therapeutic relationships while meeting service and quality expectations.
Utilization Review Nurse II
8 Months- Performed prior authorization and utilization reviews using MCG, CMS, National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), payer policies, and clinical documentation.
- Analyzed medical records to determine whether requested services met applicable clinical, benefit, and regulatory requirements.
- Identified incomplete, inconsistent, or insufficient clinical documentation requiring clarification or additional review.
Licensed Practical Nurse
16 Years- Provided direct clinical care across diverse patient populations and healthcare settings, developing extensive experience in clinical assessment, care coordination, documentation, patient safety, and interdisciplinary communication.
- Recognized changes in patient condition, potential safety concerns, and care needs requiring escalation to appropriate clinical providers.
- Maintained compliance with clinical policies, regulatory requirements, documentation standards, and patient-safety practices.
- Collaborated with nurses, physicians, ancillary clinicians, patients, and families to support safe and effective care delivery.
Education
LPN Diploma
Skills
Clinical Documentation Review
Medical Record Analysis
Clinical Quality
Workflow Optimization
Regulatory Compliance
Case Management
Discharge Planning
Process Improvement
Evidence-Based Decision Making
CMS Guidelines
MCG Guidelines
Cross-Functional Collaboration
SME & Peer Mentoring
Certification
- Licensed Practical Nurse, Tennessee, Compact
- Utilization Review-101, Certificate of Completion, Remote Learning Services, LLC, 02/01/24
Personal Information
Title: LPN
Timeline
PAC Nurse
CareCentrix
04.2024 - CurrentRead More
Managed Care Coordinator
Elevance Health
07.2023 - 04.2024Read More
Utilization Review Nurse II
Elevance Health
11.2022 - 07.2023Read More
Licensed Practical Nurse
Various Healthcare Settings
01.2006 - 01.2022Read More
Tennessee Technology Center at Jackson
LPN Diploma
Read More