Brandy Martin
Marengo,OH
Summary
Accomplished leader with expertise in utilization review leadership, strategic planning, artificial intelligence, and relationship building, enhancing operational efficiency at Allcare Georgia. Proven track record in project management and employee development, driving team performance ,and compliance with industry standards. Skilled in negotiation and decision-making. Utilizes leadership skills to drive team performance and operational excellence. Track record of delivering high-impact results through innovative problem-solving and effective communication. for adaptability, effective collaboration, and delivering measurable outcomes in dynamic environments. Strong communication and problem-solving abilities, coupled with focus on fostering productive and positive team culture.
Overview
24
24
years of professional experience
Work History
Director of Clinical Excellence and Case Managemen
Allcare Georgia
06.2025 - Current
- Developed and implemented strategic initiatives to enhance operational efficiency across departments.
- Collaborated with cross-functional teams to align project goals with organizational objectives.
- Collaborated with Healthcare Systems for Patient Referrals
- Analyzed performance and risk metrics to identify areas for process improvement and cost reduction.
- Led training sessions to elevate team skills and ensure adherence to best practices.
- Led recruiting for Allcare Georgia
- Established key performance indicators for measuring success of departmental projects.
- Spearheaded efforts to streamline workflows, resulting in improved service delivery timelines.
- Enhanced team collaboration through regular communication, goal setting, and performance evaluations.
- Strengthened internal controls by reviewing existing policies and procedures, ensuring compliance with regulatory requirements.
Utilization Review Educator
Beacon Health System Memorial Hospital
06.2018 - 06.2025
- Developed engaging lesson plans and SOP's tailored to diverse learning styles.
- Facilitated orientation and learning activities for new onboarded registered nurses to participation and understanding of utilization review processes, work flows, payors, and dneials/appeals.
- Led onboarding of new registered nurses to the department.
- Collaborated with leadership and colleagues to implement effective teaching strategies to avoid denials from payors.
- Worked closely with contacts with MCG and Xsolis
- Assisted in assessing utilization nurse progress and providing constructive feedback.
- Utilized educational technology to support interactive learning environments with artificial intelligence
- Improved patient care quality by implementing utilization review processes and ensuring adherence to industry standards.
- Contributed to multidisciplinary meetings discussing appropriate level of care determinations, discharge planning and post-acute care services.
- Worked closely with Physician Advisor
- Developed and implemented best practices for clinical documentation and care coordination across multidisciplinary teams.
- Mentored staff on effective utilization management strategies, enhancing team performance and operational efficiency.
- Established training programs for new hires on utilization review protocols and software systems.
- Evaluated and refined workflows to increase productivity within the utilization review department, driving overall effectiveness.
- Oversaw internal audits to ensure compliance with regulatory bodies such as CMS and The Joint Commission within the utilization review department.
- Developed comprehensive staff training programs to enhance employees'' understanding of utilization review principles and practices.
- Implemented evidence-based practices in the utilization review process, improving overall decision-making accuracy and effectiveness.
Registered Nurse
Indiana University
09.2013 - 04.2018
- Implemented patient care plans in collaboration with interdisciplinary teams to enhance overall patient outcomes.
- Administered medications and monitored vital signs, ensuring adherence to safety protocols and best practices.
- Educated patients and families on health management, promoting adherence to treatment plans and preventive care strategies.
- Mentored junior nursing staff, fostering a culture of continuous learning and professional development within the team.
- Led quality improvement initiatives that streamlined patient care processes, resulting in increased efficiency and satisfaction scores.
- Conducted health assessments and developed individualized nursing interventions based on comprehensive evaluations of patients' needs.
- Collaborated with healthcare professionals to develop policies that improved service delivery and compliance with regulatory standards.
- Utilized critical thinking skills to prioritize nursing interventions based on patients'' acuity levels and individual needs.
- Administered medications safely according to established guidelines while closely monitoring for side effects or adverse reactions requiring intervention.
- Enhanced patient satisfaction by providing compassionate, holistic nursing care that addressed physical, emotional, and spiritual needs.
- Assisted in the training and mentorship of new nursing staff members, contributing to a positive work environment and high-quality patient care.
- Prevented the spread of infections by consistently adhering to strict infection control protocols and educating patients on proper hygiene practices.
- Served as a preceptor for nursing students during their clinical rotations, providing valuable real-world experience and guidance to foster professional growth.
- Skillfully managed challenging patient situations using de-escalation techniques, crisis intervention strategies, and therapeutic communication skills.
- Participated in ongoing professional development opportunities to stay current on best practices in nursing care and emerging trends in healthcare delivery.
Bodily Injury Claims Specialist
Progressive Insurance
03.2002 - 07.2009
- Analyzed and processed bodily injury claims to ensure compliance with regulatory standards.
- Collaborated with medical professionals to obtain necessary documentation for claims evaluation.
- Evaluated coverage issues and negotiated settlements, maintaining positive relationships with stakeholders.
- Achieved successful claim resolutions by thoroughly investigating and evaluating bodily injury claims.
- Developed strong relationships with claimants, ensuring empathetic communication while maintaining professionalism.
- Ensured compliance with state regulations during every stage of the claims process, minimizing risk for both the company and policyholders.
- Educated policyholders about their coverage benefits, helping them understand how their policies applied to specific situations.
- Managed a high volume of cases efficiently, prioritizing tasks based on urgency and complexity.
- Utilized strong analytical skills to identify potential subrogation opportunities, reducing company payout expenses.
- Delivered exceptional customer service through consistent communication regarding updates on the status of their claims.
- Conducted timely negotiations with claimants'' representatives to reach fair settlements within policy limits.
- Maintained detailed records of each claim, streamlining the process for future reference and audits.
- Provided support to colleagues in the resolution of complex claims, sharing expertise and knowledge as needed.
Education
Bachelor of Science - Nursing
Mount Vernon Nazarene University
Mt Vernon, Ohio05-2012
Bachelor of Arts - Business Marketing
Mount Vernon Nazarene University
Mt Vernon, Ohio05-2002
Skills
- Relationship building
- Strategic planning
- Verbal and written communication
- Decision-making
- People management
- Operations management
- Project management
- Team management
- Strategies and goals
- Project coordination
- Staff management
- Employee development
- Issues resolution
- Negotiation
- Contract and vendor management
- Hiring and retention
- Rules and regulations
Timeline
Director of Clinical Excellence and Case Managemen
Allcare Georgia
06.2025 - Current
Utilization Review Educator
Beacon Health System Memorial Hospital
06.2018 - 06.2025
Registered Nurse
Indiana University
09.2013 - 04.2018
Bodily Injury Claims Specialist
Progressive Insurance
03.2002 - 07.2009
Bachelor of Science - Nursing
Mount Vernon Nazarene University
Bachelor of Arts - Business Marketing
Mount Vernon Nazarene University