Brandi Shallow
Lawton,OK
Summary
Licensed Practical Nurse with comprehensive experience in clinical documentation review, prior authorizations, medical necessity verification, and remote care coordination. Adept at interpreting medical records to support utilization management decisions in alignment with MCG/InterQual criteria and payer guidelines. Proven ability to collaborate with multidisciplinary teams to ensure appropriate, cost-effective, and high-quality care. Skilled in electronic health records (EHR) and HIPAA-compliant workflows. Seeking to apply clinical knowledge and administrative expertise in a remote role focused on optimizing care delivery and resource utilization.
Overview
11
11
years of professional experience
Work History
Clinical Nurse Review UM
TurningPoint Health Care Solutions
2023.08 - Current
- Analyzed complex clinical cases to confirm utilization criteria and document clinical rationale for timely authorization decisions.
- Maintained audit-ready records of review activities and clinical justifications to improve compliance and streamline external audits.
- Performed prospective and retrospective utilization reviews to assess medical necessity for surgical and interventional procedures, ensuring appropriate care pathways.
- Interpreted CPT/HCPCS/ICD-10 codes to ensure accurate authorizations and correct coding alignment for claims processing.
- Remote
- Contract
Licensed Practical Nurse
Comanche County Memorial Hospital
2023.11 - 2025.08
- Administered medications and treatments to patients, ensuring adherence to prescribed care plans and improving patient outcomes.
- Monitored vital signs and reported significant changes to the nursing team, facilitating timely interventions for patient safety.
- Supervised a team of licensed practical nurses, ensuring adherence to care protocols and regulatory standards to maintain high-quality patient care.
- Conducted comprehensive clinical reviews of patient care documentation to ensure adherence to regulatory standards and quality assurance protocols.
- Assessed complex patient presentations and adjusted care priorities, leading to clearer treatment plans and more efficient nursing interventions.
Patient Success Representative
Brightree, LLC
2022.04 - 2023.11
- Collaborated with cross-functional teams to streamline processes, resulting in improved operational efficiency and reduced response times.
- Utilized CRM software to track interactions and maintain accurate records of customer engagements, supporting data-driven decision-making within the team.
- Conducted comprehensive clinical reviews of patient care documentation to ensure adherence to regulatory standards and quality assurance protocols.
- Remote
Aviation Electronics Technician
United States Navy
2020.01 - 2022.09
- Conducted troubleshooting and repair of avionics systems, ensuring operational readiness of aircraft through precise diagnostics and maintenance procedures.
- Performed regular inspections and preventive maintenance on electronic equipment, reducing downtime and enhancing mission capability.
- Utilized advanced testing equipment, including oscilloscopes and multimeters, to evaluate system performance and identify faults in avionics installations.
Insurance Coordinator & Surgical Assistant
Frisco Oral & Dental Implant Surgery
2015.01 - 2020.01
- Coordinated patient insurance verifications and eligibility checks using dental management software to ensure accurate billing and coverage details.
- Managed claim submissions and follow-ups, reducing outstanding claims by maintaining organized documentation and timely communications with insurance providers.
- Trained new staff on insurance protocols and office procedures, fostering a collaborative work environment that enhanced overall team efficiency.
Education
Associate of Science - RN
Western Oklahoma State College
Lawton, Oklahoma, USA2026-05
Skills
- Medical Necessity Review, Prior Authorization, Clinical Documentation Review, Interdisciplinary Communication, Insurance Verification Processes, Clinical Documentation, Appeals & Reconsiderations, CPT/HCPCS/ICD-10 Coding, Remote Workflow, HIPAA Compliance, Level of Care Review
Licenses
Licensed Practical Nurse Oklahoma: #220426
Licensed Practical Nurse California: #758821
Timeline
Licensed Practical Nurse
Comanche County Memorial Hospital
2023.11 - 2025.08
Clinical Nurse Review UM
TurningPoint Health Care Solutions
2023.08 - Current
Patient Success Representative
Brightree, LLC
2022.04 - 2023.11
Aviation Electronics Technician
United States Navy
2020.01 - 2022.09
Insurance Coordinator & Surgical Assistant
Frisco Oral & Dental Implant Surgery
2015.01 - 2020.01
Associate of Science - RN
Western Oklahoma State College