Summary
Overview
Work History
Education
Skills
Timeline
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Brandi Hall

Saint Johns,FLORIDA

Summary

Conscientious Clinical Nurse Reviewer known for high productivity and efficient task completion. Possess specialized skills in medical chart review, utilization management, and evidence-based practice. Excel in critical thinking, communication, and time management to ensure optimal patient outcomes and healthcare standards compliance.

Overview

25
25
years of professional experience

Work History

Clinical Nurse Reviewer 1

SMRC NGS- Elevance Health
03.2022 - Current
  • Perform clinical reviews of medical records to ensure accurate coding and compliance with Medicare regulations.
  • Assess patient data, diagnoses, treatments and outcomes to determine appropriateness of care and cost effectiveness.
  • Maintain a working knowledge of CMS coverage determinations, LCDs and NCDs, CPT codes and modifiers.
  • Assess medical records to determine the appropriateness and necessity of care provided.
  • Collaborate with Noridian to ensure claims are executed efficiently and timely.

Post Anesthesia Care Unit and Surgical Admitting

Chesapeake Regional Medical Center
Chesapeake, VA
09.1999 - 03.2022
  • Assessed patient health and developed individualized care plans accordingly.
  • Provided direct nursing care to patients, including administering medications, wound care, and IV therapy.
  • Educated patients on health maintenance, disease prevention, and treatment options.
  • Performed physical examinations and assessments of patients' medical histories.
  • Collaborated with physicians in developing patient-specific treatment plans.
  • Assisted doctors during medical procedures.
  • Responded quickly to life-threatening situations by providing appropriate interventions.
  • Ensured compliance with infection control policies and procedures.
  • Maintained accurate documentation of patient records in accordance with HIPAA regulations.
  • Participated in quality improvement initiatives related to improving outcomes within the unit.
  • Promoted safety measures such as fall prevention through implementation of evidence-based practices.
  • Collaborated with anesthesiologists on preoperative preparation for surgeries.
  • Conducted pre-anesthesia assessments prior to surgery.

Education

Associate of Science - Nursing

Wytheville Community College
Wytheville, VA
09-2019

Bachelor of Science - Nursing

Chamberlain College of Nursing
06-2019

Skills

  • Evidence-Based Practice
  • Policy compliance
  • Utilization review
  • Care Coordination
  • Quality Improvement
  • Experienced Professional
  • Proficient in healthcare technologies
  • Critical thinker
  • Proven leader

Timeline

Clinical Nurse Reviewer 1

SMRC NGS- Elevance Health
03.2022 - Current

Post Anesthesia Care Unit and Surgical Admitting

Chesapeake Regional Medical Center
09.1999 - 03.2022

Associate of Science - Nursing

Wytheville Community College

Bachelor of Science - Nursing

Chamberlain College of Nursing

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Brandi Hall