Brandy Wiltse
Augusta
Summary
Nurse with 20 years of experience in delivering exceptional patient care and improving patient outcomes through effective team collaboration. Expertise in documentation improvement, case management, utilization management, and nursing leadership. Proven track record of enhancing operational efficiency and patient satisfaction in diverse healthcare settings.
Overview
19
19
years of professional experience
3
3
Certifications
Work History
CDI Specialist RN - Clinical Documentation and Quality Improvement
Central Maine Healthcare
Lewiston
10.2020 - Current
- Facilitated accurate and consistent medical record documentation to support ICD diagnosis code selection through comprehensive reviews of outpatient records.
- Ensure documentation supports accurate coding and reimbursement.
- Identified gaps in medical records and collaborated with providers to enhance documentation accuracy.
- Conducted regular reviews of patient records, ensuring integrity of documentation to support coding and reimbursement processes.
- Skilled in HCC Risk Adjustment methodologies to ensure accurate outpatient documentation and optimize value-based reimbursement.
- Provide ongoing education and updates on CDI practices and regulations.
- Educated departmental staff members on correct coding principles, practices, policies, and procedures.
- Serve as a bridge between clinical teams and coding specialists.
- Outpatient CDQI program roll-out and development from initial stages
- Oversaw quality measures to enhance operational efficiency and patient care.
- Provider education program development
- Review contract requirements for HEDIS measures
- data extraction for HEDIS measures
- Executed patient outreach for transition of care (TOC) to facilitate smooth patient transitions.
- Key Contributions:
- System wide HCC / risk adjustment Improvements
Nurse Informaticist
Hazel Hawkins Memorial Hospital
Hollister
05.2018 - 10.2020
- Manage day-to-day communications between IT staff and several outpatient clinics, nursing homes, and one main hospital.
- Educated users on healthcare products, medical technology, and EMRs, enhancing user proficiency with eClinicalWorks, Meditech, and PCC.
- Impart assistance to the user in intellispace and Philips monitoring systems to effectively detect and characterize malignancies, and perform quantification and follow-up analyses to assess treatment response.
- Implement speech recognition software package, Dragon dictation systems and provide support to the users by liaising with the product providers and clinicians.
- Implemented electronic health record systems for improved patient data management.
- Collaborated with clinical staff to enhance workflow and information sharing.
- Conducted training sessions for nursing personnel on new software, improving adoption and effective use of technology.
- Analyzed data trends to support decision-making in patient care practices.
- Assisted in system upgrades and troubleshooting technical issues promptly.
- Facilitated interdisciplinary meetings to address informatics challenges and solutions.
- Developed strategies for managing large amounts of data efficiently while ensuring accuracy.
- Coordinated activities between multiple departments including Clinical Informatics, Information Technology, Quality Improvement, Risk Management, Compliance.
- Partnered with senior leadership teams on strategic initiatives related to digital transformation efforts.
- Analyzed user feedback from clinicians and stakeholders to identify necessary system features or design changes, driving user-centered improvements.
- Key Contributions:
- Deliver Clinical IT support to over 700 end users across the Hazel Hawkins network.
- Improve the quality of patient care by helping teams to manage workflows.
MDS Coordinator lead
Riverside Health System
Hampton
02.2016 - 05.2018
- Supervised full life cycle projects for gathering information and assessing care plans, ensuring alignment with regulatory standards.
- Conducted concurrent reviews for managed care patients to ensure compliance and quality of care.
- Generated compliance and reimbursement reports while overseeing billing processes to ensure timely and accurate financial operations.
- Trained and mentored nursing staff on standards processes and methodologies.
- Spearheaded efforts to conduct higher-level training for the interdisciplinary team during EMR installation and changes.
- Utilized keen leadership abilities and communications skills to guide successful EMR deployment.
- Managed project schedules, EMR data extraction, team evaluations, coaching, mentoring, and training to enhance team capabilities.
- Established project metrics and project report schedules with key stakeholders.
- Perform retrospective review and construct denial letters for rejected claims.
- Key Contributions:
Assistant Director of Nursing
Saber Healthcare Group
Virginia Beach
07.2014 - 02.2016
- Contributed towards the management and direction of all program activities and personnel within a 90-bed facility.
- Led nursing staff to maintain high standards of patient care.
- Developed and implemented nursing policies and procedures for efficiency.
- Ensured EMR projects progressed on schedule and within scope and budget.
- Supervised training sessions for staff on EMR usage.
- Coordinated training programs to enhance staff skills and knowledge.
- Managed budgeting and resource allocation for nursing services effectively.
- Oversaw compliance with healthcare regulations and quality standards.
- Coordinated activities with other healthcare providers to ensure optimal patient outcomes.
- Provided monthly program review to C-level management including cost and schedule status.
- Key Contributions:
- Led the project and maintained accountability for the successful implementation of an EMR system.
- Effectively delivered technical support and training to nursing staff and hospital employees on best practices and procedures.
- Collaborated on the development of the case manager role.
- Managed and executed tag-free state survey effectively.
District Area Case Manager
Kindred Healthcare
Virginia Beach
07.2009 - 07.2014
- Spearheaded tasks related to day-to-day operations and implementation of policies and procedures for managed care patients.
- Established collaborative relationships with case managers from managed care companies to support better healthcare outcomes for patients.
- Coordinated patient care plans with multidisciplinary teams to enhance care delivery and patient outcomes.
- Assessed patient needs through comprehensive evaluations and health history reviews.
- Managed case documentation using electronic health record systems effectively.
- Educated patients and families on treatment options and health management strategies.
- Facilitated communication between healthcare providers and patients to ensure clarity.
- Advocated for patients' needs within the healthcare system to enhance support services.
- Participated in team meetings to discuss treatment options for complex cases.
- Provided education and counseling on health promotion, risk reduction strategies, disease prevention and self-care techniques to patients and their families.
- Utilized critical thinking skills when assessing new information or changes in a patient's condition.
- Maintained accurate records of all patient interactions according to established protocols.
- Reviewed patient cases for medical necessity and compliance with guidelines.
- Analyzed clinical documentation for accuracy and completeness in reviews.
- Communicated with patients regarding care options and insurance coverage
- Hired and trained case managers in the district to enhance team performance.
- Trained staff on utilization review processes and best practices to ensure compliance and effective case management.
- Coordinated interdisciplinary meetings to discuss complex cases and resolution strategies.
- Performed retrospective reviews and composed clinical denial letters for rejected claims in the district.
- Conducted concurrent reviews for managed care patients to assess care needs.
- Led all Medicare audits in the district, coordinating processes and compliance.
- managed contract carve outs and negotiated contract rates
- Key Contributions:
- Successfully implemented a pharmaceutical cost saving project throughout two districts with an annual cost savings of over $1M.
- Guided efforts to develop the case management role and standards for LTC within the district.
- Led an EMR documentation project that increased the capture for clinical data, promoted improved patient outcomes, and increased CMI revenue.
- Established and nurtured relationships with managed care providers to facilitate collaboration.
- Developed concurrent review processes for skilled nursing facility patients under managed care.
MDS Coordinator, case manager
Kindred Healthcare
Virginia Beach
04.2008 - 07.2009
- Fully accountable for accumulating information for assessments and care plans.
- Conducted and documented a thorough assessment of each patient's medical status before and throughout the patient's course of treatment.
- Coordinated MDS assessments and interdisciplinary care plan development for residents.
- Collaborated with interdisciplinary teams to develop care plans for residents.
- Educated staff on MDS guidelines to enhance compliance and improve resident care quality.
- Facilitated staff training on MDS processes and documentation requirements.
- Applied expert knowledge of EMR for data extraction, reimbursements, and compliance.
- Collaborated with nursing staff to ensure accurate documentation and compliance.
- Managed resident data entry into electronic health records systems efficiently.
- Communicated effectively with families regarding care plans and assessments.
- Developed individualized plans of care for each resident based on assessment findings.
- Facilitated communication between healthcare providers and clients to ensure continuity of care.
- Monitored client progress and adjusted care plans for optimal support.
- Educated clients on available resources and support services within the community.
- Conducted quality assurance audits to verify adherence to regulatory standards.
- Analyzed trends in data collected through the Minimum Data Set.
- Coordinated the completion of Minimum Data Set assessments for resident admissions.
- Participated in survey preparation activities by ensuring that all necessary documents were available during surveys conducted by state agencies or accreditation organizations.
- Conducted concurrent reviews of managed care patients' cases to ensure compliance with care standards.
- Reviewed patient cases to ensure medical necessity and adherence to compliance standards.
- Drafted denial letters and conducted retrospective reviews of denied claims to identify appeal opportunities.
- Highlighted key contributions to demonstrate impact on team and organizational goals.
- Improved the daily reimbursement rate through coordination of delivery of care involving cooperation between therapy and nursing services.
- established the need for case managers within skilled nursing facilities
- Facilitated team meetings with members from other departments such as Social Services, Dietary, Activities, Rehabilitation services, to discuss resident issues and concerns related to the MDS process.
- Improved the daily reimbursement rate through coordination of delivery of care involving cooperation between therapy and nursing services.
- established the need for case managers within skilled nursing facilities
Charge Nurse, Acute Dialysis Unit
Davita Dialysis, Maryview Hospital
Portsmouth
03.2007 - 04.2008
- Evaluated patient response to interventions and adjusted plan of care to optimize outcomes.
- Administered medications and treatments, actively assisting patients to ensure high-quality care.
- Coordinated with interdisciplinary team to implement and monitor patient care plans effectively.
- Educated patients and family regarding treatments and dialysis.
- Applied comprehensive assessment skills within scope of practice.
- Enhanced critical thinking skills by caring for patients with complex and interrelated diagnoses.
- Key Contributions:
Education
Master of Science in Nursing - Nursing Informatics
Chamberlain College of Nursing
Downers Grove, Illinois01-2018
Registered Nurse -
Sentara School of Nursing
Chesapeake, Virginia01-2006
Skills
- Clinical documentation
- Quality enhancement
- HCC risk adjustment
- Patient care planning
- Case Management
- EMR/EHR Systems
- Clinical Data Management
- ICD coding
- Data analysis
- Healthcare compliance
- Risk management
- Process Improvements
- Provider education
- Provider Querying
- Budgeting & Cost Reduction
- Cost Savings
- Nursing Management
- Stakeholder Communication
- Team coordination
- Patient care coordination
- Motivational Leadership
- Interpersonal Skills
- Attention to detail
- Team coordination
- Patient care coordination
- Case management
Personal Information
Title: RN
Certification
CCDS-O
Work Preference
Location Preference
RemoteSalary Range
$71000/yr - $200000/yrTimeline
CDI Specialist RN - Clinical Documentation and Quality Improvement
Central Maine Healthcare
10.2020 - Current
Nurse Informaticist
Hazel Hawkins Memorial Hospital
05.2018 - 10.2020
MDS Coordinator lead
Riverside Health System
02.2016 - 05.2018
Assistant Director of Nursing
Saber Healthcare Group
07.2014 - 02.2016
District Area Case Manager
Kindred Healthcare
07.2009 - 07.2014
MDS Coordinator, case manager
Kindred Healthcare
04.2008 - 07.2009
Charge Nurse, Acute Dialysis Unit
Davita Dialysis, Maryview Hospital
03.2007 - 04.2008
Master of Science in Nursing - Nursing Informatics
Chamberlain College of Nursing
Registered Nurse -
Sentara School of Nursing