Summary
Overview
Work History
Education
Skills
Certification
Timeline
background-images

Ebony Brown

Oviedo,FL

Summary

Experienced Registered Nurse with expertise in Utilization Review, Preauthorization, Concurrent Reviews, and Patient-Care Practices. Skilled in Medical/Surgical, Leadership/Mentorship, and Home Health. Strong background in Claims/Billing, Appeals/Denials, and Care Coordination. Demonstrated ability in high-level critical thinking and attention to detail.

Overview

8
8
years of professional experience
1
1
Certification

Work History

RN Case Manager

AdventHealth
03.2025 - Current
  • Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
  • Monitored ongoing cases closely, adjusting case management strategies as needed based on evolving circumstances or new information.
  • Educated clients on available programs, benefits, and services, empowering them to make informed decisions about their care needs.

Independent Provider

Ohio Department of Medicaid
08.2017 - Current
  • Assisted in the wellness coaching of preventative health options to patients/families.
  • Developed and created care plans using critical thinking skills to assist patients at home.
  • Educated patient and caregiver regarding medications and procedures.

Nurse Reviewer, Utilization Review

Elevance Health
05.2023 - 11.2024
  • Reviewed 60-80 provider requests daily for medical procedures as requested by the health plan.
  • Evaluated and assessed all clinical information collected for the patient's healthcare needs.
  • Reviewed and processed outpatient prior authorization requests to evaluate medical necessity, ensuring alignment with established clinical guidelines and payer requirements including cardiac procedures, imaging, surgical procedures, transplants, and durable medical equipment.

Registered Nurse, Case Management, Contract

Bridge Home Health and Hospice
09.2022 - 12.2022
  • Displayed effective communication skills in initiating therapeutic relationships with patients for optimal health.
  • Works in collaboration with the interdisciplinary team to assess the needs of the 40-60 patients.
  • Managed and treated health problems, ranging from common to serious, chronic, and complex for adults and the elderly by continuously fostering improvement.

Registered Nurse, Medical Surgical

Firelands Regional Medical Center
10.2021 - 10.2022
  • Performed daily assessments to patients from the OR, ER, and ICU.
  • Used strong oral and written communication with physicians and healthcare teams to provide optimum care to patients.
  • Educated clients, patients, and caregivers on medical diagnoses, treatment options, chronic disease self-management, and wound management to help achieve peak life expectancy.

Registered Nurse, Home Health, Contract

Caretenders, LHC
04.2021 - 09.2021
  • Provided prescribed medical treatment and personal care services to the ill, injured, convalescent, and handicapped persons.
  • Championed patient education initiatives, empowering families with knowledge and resources to manage health conditions effectively.
  • Fostered collaborative relationships with interdisciplinary teams, leading to more comprehensive care plans that improved patient outcomes and engagement.

Education

Utilization Review 101 Certificate -

Remote Learning Services, LLC

Heidi's Data Abstraction 101 Certificate - undefined

Remote Learning Services, LLC

Registered Nurse Diploma - LPN to RN Diploma Program

Sandusky Career Center

Associate in Science - undefined

Bowling Green State University

Licensed Practical Nurse - undefined

Sandusky Career Center School of Practical Nursing

Skills

  • Admissions evaluation
  • Appeals and denials analysis
  • Detail-oriented approach
  • Interdisciplinary care management
  • Coordinated assessments
  • Experience with multiple EMR platforms
  • Strategic problem-solving
  • Home health care
  • Proficient in claims processing and billing
  • Team leadership
  • Managed care coordination
  • Proficient in MCG and InterQual assessments
  • Medical/ Surgical
  • Medicare and Medicaid proficiency
  • Patient-Care Practices
  • Insurance preauthorization
  • Rehabilitation for elderly patients
  • Retroactive reviews
  • Effective time management
  • Utilization review training

Certification

  • Registered Nurse, Compact
  • 2025-10
  • Ohio Board of Nursing
  • Registered Nurse
  • Indiana Board of Nursing
  • 2025-03
  • Nevada Board of Nursing
  • Kentucky Board of Nursing

Timeline

RN Case Manager

AdventHealth
03.2025 - Current

Nurse Reviewer, Utilization Review

Elevance Health
05.2023 - 11.2024

Registered Nurse, Case Management, Contract

Bridge Home Health and Hospice
09.2022 - 12.2022

Registered Nurse, Medical Surgical

Firelands Regional Medical Center
10.2021 - 10.2022

Registered Nurse, Home Health, Contract

Caretenders, LHC
04.2021 - 09.2021

Independent Provider

Ohio Department of Medicaid
08.2017 - Current

Heidi's Data Abstraction 101 Certificate - undefined

Remote Learning Services, LLC

Registered Nurse Diploma - LPN to RN Diploma Program

Sandusky Career Center

Associate in Science - undefined

Bowling Green State University

Licensed Practical Nurse - undefined

Sandusky Career Center School of Practical Nursing

Utilization Review 101 Certificate -

Remote Learning Services, LLC

Similar Profiles

CREATE PROFILE
Ebony Brown