Brandie Swegles
Nursing
Plymouth,MI
Summary
Productive mentor and natural leader focused on fostering a positive collaborative environment. I am a Masters prepared Registered Nurse who brings talents in case management, education, quality, and leadership. Special projects management, policy development, quality audit and reviews, and utilization management are additional areas of expertise.
Overview
16
16
years of professional experience
Work History
RN Care Review Coordinator
Molina Healthcare
11.2024 - Current
- Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.
- Conducts inpatient reviews to determine financial responsibility for Molina Healthcare, providers, and its members.
- Completed prior authorization reviews and/or related duties as needed.
RN Care Coordinator
Corewell Health
Farmington Hills, MI
03.2024 - 11.2024
- Collaborated with physicians, nurses, social workers and other healthcare professionals to coordinate efficient discharges.
- Identified potential barriers that could delay or prevent safe discharge from the hospital environment.
- Ensured compliance with federal regulations related to Medicare and Medicaid reimbursement guidelines.
RN Care Manager
Strive Health
Denver, CO
11.2023 - 03.2024
- Assessed patient health and developed individualized care plans accordingly.
- Educated patients on health maintenance, disease prevention, and treatment options.
Case Manager/Patient Care Coordinator
Veteran Administration Hospital
Detroit, MI
06.2023 - 09.2023
- Promoted collaboration across multiple service lines to support Primary Care Clinic both by face to face direct patient care, inpatient walk-ins, RN Telephone Triage, and management of comorbidities of CHF, COPD, Diabetes, and Hypertension.
Pre-Service Coordinator
naviHealth
Brentwood, TN
09.2019 - 06.2023
- Clinical gatherer and authorization document creator for all prospective and concurrent requests within established parameters for IRF/LTAC admits via home, SNF, IRF, LTAC, or Acute
- Development of educational/training material for IRF/LTAC Pre-Service Department as Lead preceptor with 10 direct reports.
- Identified opportunities for process improvements to streamline pre-authorization workflow.
- Collaborated with other departments to create a comprehensive curriculum for new employees.
- Provided guidance on regulatory requirements such as HIPAA, OSHA, and JCAHO standards.
- Organized workshops to educate healthcare providers about new medical technologies or procedures with Hot Topic Tuesdays run via Microsoft Teams.
Lead RN Case Manager
Detroit Medical Center
Detroit, MI
10.2016 - 09.2019
- Responsible for quality metrics, expected performance standards, attend and provide recommendations for QAI standards, staff education, and productivity outcomes both in personal patient case load coverage and for case management department team.
- Conducted regular meetings with both RN direct reports of 15 and case management department team members to discuss caseloads and provide guidance on complex cases.
- Assisted in the development of new programs and initiatives aimed at improving service delivery which garnered an increase in 71% compliance to 100% of both corporate and federal initiatives.
- Ensured compliance with all applicable laws, regulations, policies, procedures and standards of practice.
IHA Complex Care Coordinator
IHA
Ann Arbor, MI, MI
10.2014 - 10.2016
- Facilitated on-going assessment of patient and family needs and oversaw implementation of interdisciplinary team plan of care.
Discharge Coordinator
Detroit Medical Center (DMC) RPH,SGH,CSH
Detroit, Mi
07.2025 - Current
- Identified and referred patients to social work department for additional coverage and services.
- Worked with utilization review to establish prior authorization for timely discharges.
- Communicated with referral providers about new referrals and verified receipt of necessary information prior to arrivals.
- Solved problems related to abrupt changes in discharge, coordinated updates and communicated discharge plans.
- Coordinated travel arrangements and contacted family with travel information.
- Kept high average of performance evaluations.
- Built highly-efficient administrative team through ongoing coaching and professional development opportunities.
- Oversaw appointment scheduling and itinerary coordination for both clients and personnel.
- Trained team members on new hotel services and products to support promotional efforts.
- Optimized organizational systems for payment collections, AP/AR, deposits, and recordkeeping.
- Managed supervisor itinerary and appointments and streamlined scheduling procedures.
- Completed bi-weekly payroll for [Number] employees.
- Monitored front areas so that questions could be promptly addressed.
- Conducted ongoing reviews of program financial systems to assess cost control measures.
- Improved customer satisfaction scores through application of superior conflict resolution and problem-solving skills.
- Developed internal requirements and standards to minimize regulatory risks and liability across programs.
- Organized meetings for executives and coordinated availability of conference rooms for participants.
- Implemented project management techniques to overcome obstacles and increase team productivity.
- Provided backup to front desk to step in to assist with various tasks whenever employee was absent or at lunch.
- Improved office operations by automating client correspondence, record tracking and data communications.
- Organized spaces, materials and catering support for internal and client-focused meetings.
- Interceded between employees during arguments and diffused tense situations.
- Coordinated individual duties after careful evaluation of each employee's skill level and knowledge.
- Resolved issues through active listening and open-ended questioning, escalating major problems to manager.
- Hired, managed, developed and trained staff, established and monitored goals, conducted performance reviews and administered salaries for staff.
- Facilitated timely referrals to alternate levels of care and assisted family or guardian with completion of applications.
Utilization Review Nurse
Detroit Medical Center- Detroit Receiving Hospital
Detroit, MI, MI
10.2013 - 10.2014
- Determined medical necessity and cost-effectiveness of services through utilization review processes.
Education Coordinator/Quality RN
Fresenius Medical Care Dialysis
Plymouth, MI
10.2009 - 10.2013
- Leadership role in coordination of educational and compliance proficiencies for 5 FMC Corporate Dialysis Clinics.
- Responsibility for on-site training, monthly CQI meetings, and quality/compliance adherence and audits throughout Michigan and Ohio including: new operating systems, charting programs, corporate initiatives, policy, and procedures
- Focus on creating & sustaining a participatory environment; employing evidence-based practice and measuring outcomes; integrating best practice research with expertise & patient values for optimal care; application of performance improvement methodologies to minimize waste, decrease errors, increase efficiency with the goal of patient care improvement and utilization cost control sustainability.
Education
Master of Science - Nursing Administration
University of Phoenix
Tempe, AZ10.2017
Bachelor of Science - Nursing
University of Detroit Mercy
Detroit, MI05.2007
Bachelor of Science - Psychology
Central Michigan University
Mount Pleasant, MI05.1996
Skills
- Milliman, CarePort, MS office Suite, EPIC, and Powerchart/Cerner
- Program Development, Project Management, and Quality Improvement
- Discharge Planning and Utilization
- Disease Management
- Clinical Information System Management
- Experience and knowledge of HMO, PPO, TPA, PHO and Managed Care functions including understanding of claims administration, including CPT-4 codes, and DRGs
Timeline
Discharge Coordinator
Detroit Medical Center (DMC) RPH,SGH,CSH
07.2025 - Current
RN Care Review Coordinator
Molina Healthcare
11.2024 - Current
RN Care Coordinator
Corewell Health
03.2024 - 11.2024
RN Care Manager
Strive Health
11.2023 - 03.2024
Case Manager/Patient Care Coordinator
Veteran Administration Hospital
06.2023 - 09.2023
Pre-Service Coordinator
naviHealth
09.2019 - 06.2023
Lead RN Case Manager
Detroit Medical Center
10.2016 - 09.2019
IHA Complex Care Coordinator
IHA
10.2014 - 10.2016
Utilization Review Nurse
Detroit Medical Center- Detroit Receiving Hospital
10.2013 - 10.2014
Education Coordinator/Quality RN
Fresenius Medical Care Dialysis
10.2009 - 10.2013
Master of Science - Nursing Administration
University of Phoenix
Bachelor of Science - Nursing
University of Detroit Mercy
Bachelor of Science - Psychology
Central Michigan University