Alisha Brand
White Bluff,TN
Summary
Goal-driven Healthcare Administration professional well-versed in recruiting, training and managing employees to provide exceptional services. Highly organized and hardworking with excellent planning and program management skills. Licensed in Tennessee.
Overview
20
20
years of professional experience
3
3
Certification
Work History
Process Expert II
Carelon Post-Acute Solutions
02.2023 - 10.2023
- Led process improvement projects resulting in efficiency gains and cost savings
- Analyzed data to identify bottlenecks and implemented solutions to streamline processes
- Collaborated with cross-functional teams to implement and monitor process improvements.
- Trained team members on new processes to ensure seamless adoption and maintain operational excellence.
- Analyzed complex data sets related to process performance providing valuable insights into trends, patterns, or anomalies requiring further investigation or action.
- Streamlined processes for increased productivity through the use of automation tools.
Clinical Trainer
myNexus
11.2019 - 02.2023
- Conducted interactive training sessions for healthcare professionals to enhance clinical skills
- Developed customized training modules focusing on evidence-based practices and patient care
- Facilitated simulations and case studies to improve critical thinking and decision-making
- Evaluated participants' performances through assessments and provided constructive feedback for improvement.
- Provided ongoing mentorship and support for trainees, encouraging the continued application of skills learned during training sessions in their daily clinical practice.
- Increased overall proficiency of clinical staff by conducting targeted skills development sessions for identified areas of weakness.
Care Manager I
MyNexus
03.2018 - 11.2020
- Conducted authorization reviews for home health care by utilizing appropriate policies, clinical, and department guidelines
- Collaborated with healthcare professionals to coordinate and organize healthcare services effectively
- Conducted initial and subsequent authorization requests and determined if presented clinical information met medical necessity criteria or required additional medical necessity review.
- Managed complex caseloads, ensuring timely assessment, intervention, and documentation for optimal care outcomes.
- Communicated with healthcare providers to facilitate continuity of care.
- Utilized electronic health records systems proficiently for efficient documentation of clinical information according to regulatory standards.
Admissions Manager
West Meade Place
01.2018 - 03.2018
- Conducted pre-admission assessments and benefits verifications
- Coordinated safe transport of patients to include picking up patients for transport to facility and/or transport for admitted patients to non-emergency medical appointments
- Responsible for maintaining admission reports by collecting, analyzing, and summarizing data and trends.
- Improved overall efficiency of admissions office by implementing new software systems and automating routine tasks.
Medical Review Nurse III
Strategic Health Solutions
01.2016 - 11.2017
- Conducted in-depth medical record review and assessment for complex cases
- Coordinated with healthcare providers to ensure appropriate patient care and treatment plans
- Utilized clinical expertise to determine medical necessity and appropriateness of services
- Provided guidance and support to team members on complex medical cases.
- Ensured patient safety by monitoring trends in utilization management data, identifying potential risks associated with inappropriate care provision or resource allocation.
- Reduced turnaround time for claim processing by utilizing advanced software tools to streamline workflows effectively.
- Supported legal and compliance teams in investigations related to medical fraud, waste, and abuse through meticulous case analysis.
- Improved overall efficiency by streamlining the review process, creating clear documentation, and developing strong communication channels.
Utilization Nurse
eviCore
05.2014 - 10.2015
- Conducted initial assessments and reassessments to determine appropriateness of patient care plans
- Collaborated with interdisciplinary team to develop and implement effective utilization review processes
- Reviewed medical records to ensure medical necessity and appropriateness of treatments.
- Collaborated with interdisciplinary teams for optimized patient treatment plans and outcomes.
Regional Quality Manager
Guardian Home Care
01.2008 - 04.2014
- Led cross-functional teams to implement quality management systems, driving process improvements
- Developed and executed training programs to enhance staff understanding of quality standards
- Conducted regular audits to ensure compliance with regulatory requirements and company quality standards
- Collaborated with suppliers to address quality issues and implement corrective actions.
- Collaborated with cross-functional teams to identify areas for improvement in products and processes.
- Implemented process improvements that reduced production lead times while maintaining high levels of product quality.
- Oversaw budgetary planning for the Quality Department, allocating resources effectively to achieve desired outcomes within financial constraints.
Education
Master of Business Administration -
Southern New Hampshire University
Hookset, NH11.2023
Bachelor of Science Degree -
Middle Tennessee State University
Murfreesboro, TN05.2022
Associate of Science Degree -
Nashville State Community College
Nashville, TN05.2016
Licensed Practical Nurse Diploma -
Tennessee College of Applied Technology
Dickson, TN04.2002
Skills
- Critical Thinking
- Organization
- Project Management
- Teamwork
- Dependability
- Quality Improvement
- Visio
- Workflow Design
- Process Mapping
- Teamwork and Collaboration
- Problem-Solving
- Time Management
- Reliability
- Organizational Skills
- Team Collaboration
Certification
Leadership Theory Certificate
Leading People and Managing Change Certificate
Communication and Problem-Solving Certificate
Coaching/Mentoring Certificate
Timeline
Process Expert II
Carelon Post-Acute Solutions
02.2023 - 10.2023
Clinical Trainer
myNexus
11.2019 - 02.2023
Care Manager I
MyNexus
03.2018 - 11.2020
Admissions Manager
West Meade Place
01.2018 - 03.2018
Medical Review Nurse III
Strategic Health Solutions
01.2016 - 11.2017
Utilization Nurse
eviCore
05.2014 - 10.2015
Regional Quality Manager
Guardian Home Care
01.2008 - 04.2014
Master of Business Administration -
Southern New Hampshire University
Bachelor of Science Degree -
Middle Tennessee State University
Associate of Science Degree -
Nashville State Community College
Licensed Practical Nurse Diploma -
Tennessee College of Applied Technology
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