Gaylene Brandenburg
Ascension St Vincent Hospital
1
Certification
2027
years of professional experience
Dedicated Utilization Management Nurse with extensive experience in interdisciplinary collaboration and staff mentorship. Skilled in problem-solving and developing strategies that promote adherence to care guidelines, driving improved patient outcomes and operational efficiency.
Work History
Utilization Managment
12 Years 2 Months- Analyzed utilization data to identify trends and optimize resource allocation.
- Developed and implemented strategies to enhance patient care efficiency.
- Collaborated with clinical teams to ensure adherence to care guidelines and protocols.
- Led interdisciplinary meetings to address utilization challenges and promote best practices.
- Mentored staff on effective utilization review techniques and documentation standards.
- Enhanced patient care by conducting thorough utilization reviews and coordinating with healthcare providers.
Utilization Review Nurse
- Conducted comprehensive medical necessity reviews for patient admissions and continued stays.
- Collaborated with healthcare teams to develop effective care plans aligned with clinical guidelines.
- Ensured compliance with regulatory standards through meticulous documentation and reporting practices.
- Utilized electronic health record systems to track patient information and streamline review processes.
- Performed prior authorization review of services requiring notification.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Obtained authorizations from multiple insurance carriers for various levels of care.
Clinical Documentation Specialist
- Reviewed clinical documentation for accuracy and compliance with regulatory standards.
- Collaborated with healthcare providers to clarify and enhance medical record completeness.
- Ensured timely completion of medical records while maintaining strict confidentiality protocols.
- Communicated with physicians, nurses and other caregivers to explain importance of accurate and clear documentation.
- Managed electronic clinical documentation and uploaded changes or updates using 3M.
Inpatient Payor Specialist/Utilization Management Nurse
- Conducted comprehensive reviews of patient cases for appropriate care authorization
- Applied critical thinking skills to assess complex medical cases and determine appropriate levels of care in accordance with industry benchmarks.
- Increased efficiency by automating routine tasks with software solutions.
- Implemented process improvements to enhance efficiency in case review workflow
Education
Bachelor of Science - Nursing
Associate of Science - Nursing
Bachelor of Arts - Social Work
Skills
Resource optimization
Critical thinking
Documentation accuracy
Healthcare regulations
Teamwork and collaboration
Attention to detail
Problem-solving abilities
Multitasking Abilities
Excellent communication
Computer skills
Team leadership
Certification
- Accredited Case Manage RN- (ACM)
Timeline
Utilization Managment
Ascension St Vincent Hospital
06.2014 - CurrentRead More
Utilization Review Nurse
Community Health Network
2024 - 2025Read More
Clinical Documentation Specialist
Parkview Regional Medical Center
2023 - 2024Read More
Inpatient Payor Specialist/Utilization Management Nurse
Eskenazi Health Indianapolis
2019 - 2023Read More
Indiana University
Bachelor of Science from Nursing
Read More
Indiana State University
Associate of Science from Nursing
Read More
Indiana State University
Bachelor of Arts from Social Work
Read More