BRIGETTE RAILE

• Supervised and led nursing staff to support clinical operations, enhancing high-quality patient care. Conducted annual performance evaluations and facilitated hiring, onboarding, and training of new staff to strengthen team capabilities. Investigated clarity events related to clinic operations to enhance patient safety and quality improvement. Oversee the ordering and management of clinic medications and vaccines to maintain accurate inventory and ensure availability. Monitored compliance with state and federal vaccination requirements, ensuring adherence to Vaccine for Children (VFC) program and adult immunization standards.

• Developed and implemented occupational health program at Coteau, enhancing employee health initiatives. Planned and conducted employee wellness events at various businesses, fostering community engagement in health and well-being. Perform triage and clinical assessments of employees at occupational health sites, evaluating concerns and determining appropriate next steps for care. Coordinated access to virtual care services, facilitating timely connection between employees and healthcare providers for evaluations and treatments.

• Clinic specialties include: Family Practice, Internal Medicine, Pediatrics, Behavioral Health, and Eye Care
• Interim Supervisor March 2022-June 2022: Orthopedics, Podiatry, Spine/Physical Medicine Rehab, Rheumatology and Urology
• Co-supervised a team of 45 medical professionals, including medical assistants, licensed practical nurses, registered nurses, and certified ophthalmic assistants across the clinical setting.

• Supervises 20 medical professionals including medical assistants (MAs), licensed practical nurses (LPNs), and registered nurses (RNs) across the clinical setting. Ensure clinic operations comply with applicable regulations, policies, and standards. Assesses staffing needs and oversees hiring, onboarding and training of new hires. Identify staff education and development opportunities to strengthen clinical competency and support continuous improvement. Conduct monthly individual check-ins with staff members to provide support, address concerns, and promote professional growth. Facilitate monthly staff meetings to encourage communication, and alignment with clinic goals. Foster team oriented work environment through effective communication, organization, and collaborative leadership.
• Supervised nursing staff across Franciscan Medical Group ambulatory clinic operations.
• Managed staff schedules, assignments, and daily coverage needs.
• Coordinated patient care workflows with providers and clinical support teams.
• Managed clinic specialties in endocrine, nephrology, and eye care to provide comprehensive patient services.

Review and investigate service appeal requests for Medicaid, Ambetter, and Apple Health Core Connection members involving denied medical services and medications. Analyze medical documentation and compile findings into comprehensive reports, evaluating decisions against applicable policies, standards and clinical guidelines. Communicated appeal determinations and outcomes to patients and healthcare providers, ensuring clarity and professionalism in all interactions. Assisted with NCQA audits, contributing to quality assurance efforts and regulatory compliance. Conducted medical necessity reviews for provider claims disputes, evaluating service adherence to established clinical criteria and guidelines.

• Coordinated appeals and grievance cases for health plan members and providers.
• Reviewed medical records and denial letters for appeal readiness.
• Interpreted Coordinated Care policies, benefits, and authorization requirements.

• Reviewed prior authorization requests for Medicaid, Ambetter, and Apple Health Core Connection members to ensure compliance with policy and guidelines. Investigate denied medical services and medications by reviewing relevant documentation, compiling findings, and evaluating decisions against applicable policies, standards, and clinical guidelines. Communicated appeal determinations and outcomes to patients and health care providers clearly to facilitate understanding and compliance. Assisted with National Compliance Quality Assurance (NCQA) audits, contributing to quality assurance and regulatory compliance efforts.

• Cared for 4-6 patients with a variety of medical needs requiring inpatient care. Performed various nursing skills including: IVs, foley catheters, NG tubes, blood sugar checks, injections, wound care, etc. Diabetes paid for skills educator on the unit. Preceptor for new nurses coming to the unit. Assigned nursing roles for the unit during shifts. I was in constant communication with the staffing office regarding unit census. Assisted with codes and rapid responses. Acted as resource for other nurses on the unit. Assisted unit manager with various tasks on the unit.

• Cared for 3-4 patients requiring inpatient telemetry monitoring. Performed various nursing skills including IVs, catheters, NG tubes, blood sugar checks, injections, and wound care. Precepted new nurses joining the unit. Provided patient education. Assisted with managing the telemetry unit as charge nurse. Completed nursing and CNA assignments. Followed state mandated nurse-to-patient ratios. Assisted during code situations throughout the hospital. Served as a resource for other nurses.

• Provided patient care in rehabilitation, assistive care, and long-term care units. Administered medications, respiratory treatments, injections, blood draws, blood glucose checks and EKGs. Reported change of condition to providers.

• Care of patients in a long term care facility. Administered medications, respiratory treatments, blood glucose check and other various nursing tasks. Made CNA assignments.

• Assisted residents with activities of daily living. Assisted residents with feeding and ambulation. Reported changes in condition to nursing staff.