BRANDI J. PITTS
Statham
Summary
Healthcare professional with substantial experience in utilization review and patient care management. Known for precision in evaluating patient treatment plans and making critical decisions to optimize resource use. Valued team collaborator with focus on achieving impactful results and adapting to dynamic healthcare environments.
Overview
31
31
years of professional experience
Work History
Utilization Review Nurse
Acrisure LLC/ Ascential Care Partners
01.2024 - Current
- Reduced healthcare costs through efficient utilization of resources and identification of unnecessary treatments or procedures.
- Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
- Maintained professional competence by staying current on industry trends, best practices, and regulatory requirements specific to utilization review nursing.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
LPN/Advice Nurse/Neuroscience Lab
Northeast Georgia Physicians Group
11.2018 - 12.2023
- LPN that helps run a fast pace Family Practice office
- In charge of all advice calls and medication refills
- Will complete Prior Authorizations (PA) when needed
- Completes forms for patients such as STD,LTD and FMLA
- In charge of keeping updated numbers and stock on hand for Covid vaccines and our VFC
- My daily schedule daily includes patient who need to update their immunizations, wound care, suture/staple removal or monthly injections to name a few types of appointments
- I have the skill set to check in patients, assess and prepare them for one of our 4 providers, make them an appointment if needed and draw and process any labs ordered
- Runs Neuroscience Lab that includes four departments
- Ensures that labs are ordered correctly and attached to the correct ICD 10 code using
- EPIC system
- Draw labs, process and pack for shipment to correct destination determined by patient's insurance
- Do follow-up on labs working with MAYO, ARUP, Quest and Labcorp
- Cross trained to work as a floor nurse in the Neurology, Neurosurgery and Interventional Pain Management departments
- Preparing patients to be seen by the doctors by obtaining vital signs and reason for visit
- Trained to complete Prior Authorizations for Neurology medications
- Will work with new patient scheduling, calling patient with referrals to
- Complete a questionnaire, obtain past medical records and then schedule for appointment.
Charge Nurse, Breast Surgeon Nurse
Well Star Medical Group
05.2017 - 11.2018
- Prepare patients for doctor using EPIC, obtain reason for visit, collect vital signs
- Assist in Ultra Sound guided biopsies and Skin punch biopsies
- Complete paperwork and do patient teaching for breast surgery
- Do patient teaching for new cancer consults
- Order test for patient; MRI, Mammograms, X-rays
- Remove drains from post-op patients
- Obtain blood samples for genetic testing
- Call in medications ordered by surgeon
Medical Case Manager
The Hartford
06.2010 - 04.2017
- Long Term Disability/Nurse Intake
- Short-term and Long-term Disability claims with complex medical conditions referred for medical assessment; clarification of limitations/restrictions and/or case management
- Work closely with the STD/LTD Claim Team to identify appropriate claim referrals and effectively assess claims to ensure they reach the appropriate claim outcome
- Collaborate with Rehabilitation Case Managers, Ability Analysts, employees, Policyholders, and Healthcare Providers to facilitate and coordinate case management strategies to facilitate a potential Return to Work
- Clearly document and track efforts and outcomes
- Periodically participate and facilitate training programs and/or presentations Gather, receive and document necessary information from claimants and/or representatives to initiate and begin evaluation of disability claim
- Refer to case templates to identify any account specific instructions that require customized communications to claimant at intake
- Customize /claimant interview to obtain medical information specific to functional limitations and work requirements in order to determine if limitations are reasonable and medically supported
- Research and find the best ICD 9/10 codes and CPT codes needed to process the claim
- Determine medical complexity and appropriate duration assignment and/or a medical milestone for those claims assigned a duration/milestone
- Discuss and assess job modification and return to work expectations as appropriate to the claim
- Provide responsive, knowledgeable, empathetic, and courteous service in all customer interactions, both internal and external
- Clearly and concisely document clinical impressions to enable Claims Ability Analyst to make an appropriate claim decision based on claimant's condition and functionality
Staff Nurse/LPN, Family Practice Nurse
North Atlantic Primary Care
10.2009 - 05.2010
- Under the direction of 5 doctors and 4 physician assistances
- Prepare patients for doctors, obtain reason for visit, collect vital signs
- Call in medications ordered by the doctor
- Order test for patients; MRI, CT, Ultra Sounds, and X-rays
- IV therapy
- Call back patients with messages from doctors
- Patient education on diabetes and new medications
Staff Nurse/LPN
North Side Hospital
06.2008 - 10.2009
- Med/Surg unit
- Assigned 7 patients per shift
Staff Nurse/Acting Charge Nurse/Call Center Medication and Lab Nurse/Employee Health Nurse
Kaiser Permanente
02.2000 - 06.2008
- Pediatric nurse
- Under the direction of 3 doctors
- Medication ordering for pediatric department
- Train all new floor staff for department
- Help implement Health Connect in GA region
- Conduct Hedis measures for all children in need of immunizations Internal Medicine/Pediatric
- Under the direction of 3 doctors
- Prepare patients for physicians, obtain reason for visit, collect vital signs
- EKG's
- Triage walk-in patients and emergency phone calls
- Allergy injections Fill prescriptions with physician's order IV Therapy
Charge Nurse
Birmingham Green
09.1995 - 01.2000
- Adult Care Residents
- Observe and report symptoms of sixty residents
- Administer medication as prescribed by the resident's physician
- Check, record and order new medications and reorder existing medications as needed
- Supervise the CNA's in their daily job assignments
Evening Shift Nurse
Marshall Manor
03.1994 - 08.1995
- Alzheimer's Unit
- Oversee the resident care activities
- Schedule and coordinate the evening shift aides
- Participate in the development and implementation of Resident Care Plans
- Administer medication prescribed by the Resident's Physician
- Provide informed input in the ordering of medical supplies
- Assist in the training of Nurses' Aide
Education
I.V. Therapy - Fundamentals of Infusion Therapy
Neighborcare Pharmacy
Chantilly, VA01.2000
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Northern Virginia Community College
Falls Church, VA01.1996
Nursing Diploma - LPN
Prince William County School of Practical Nursing
Manassas, VA01.1994
High School Diploma - undefined
South Lakes High School
Reston, VA01.1987
Skills
- Understanding of neurosciences
- Medical-surgical expertise
- Medical case management expertise
- Disability assessment
- Process prior authorizations
- Comprehensive documentation skills
- Clinical utilization review
- Records analysis
- Development of patient care plans
- Prior authorization
- Hospitalized patient support
Timeline
Utilization Review Nurse
Acrisure LLC/ Ascential Care Partners
01.2024 - Current
LPN/Advice Nurse/Neuroscience Lab
Northeast Georgia Physicians Group
11.2018 - 12.2023
Charge Nurse, Breast Surgeon Nurse
Well Star Medical Group
05.2017 - 11.2018
Medical Case Manager
The Hartford
06.2010 - 04.2017
Staff Nurse/LPN, Family Practice Nurse
North Atlantic Primary Care
10.2009 - 05.2010
Staff Nurse/LPN
North Side Hospital
06.2008 - 10.2009
Staff Nurse/Acting Charge Nurse/Call Center Medication and Lab Nurse/Employee Health Nurse
Kaiser Permanente
02.2000 - 06.2008
Charge Nurse
Birmingham Green
09.1995 - 01.2000
Evening Shift Nurse
Marshall Manor
03.1994 - 08.1995
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Northern Virginia Community College
Nursing Diploma - LPN
Prince William County School of Practical Nursing
High School Diploma - undefined
South Lakes High School
I.V. Therapy - Fundamentals of Infusion Therapy
Neighborcare Pharmacy
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