Keria Brooks
Mansfield,OH
Summary
Proficient LPN WITH 9+ YEARS working in managed care organizations and performing medical necessity and chart auditing and 10+ years clinical expertise. Transitioning into tehe technology industry and searching for a healthcare strategist or sales engineer position.
Overview
9
9
years of professional experience
Work History
LPN Office Nurse
Avita Hospital
Galion, OH
04.2024 - Present
- Reviewed patient chart information accurately and efficiently in the electronic medical records system.
- Ensured proper administration of prescribed vaccines, medications, controlled substances and narcotics. Stored sterilized instruments, equipment and supplies.
- Gained expertise in understanding patient needs through effective telephone interactions, resolving issues promptly while adhering to established policies.
Clinical Excellence Nurse
Centene Corporation
Remote
02.2023 - 09.2023
- Reviewed and completed audits for all adverse decisions for members of the health plan to remain in compliance.
- Reviewed Federal and Local guidelines to meet general accreditation status with regard to denial letters.
- Wrote denial letters that promoted consistency and accuracy that were compliant with Medicare, NCQA, URAC and HIPPA guidelines.
- Maintained production and excellent quality standards.
- Sustained current knowledge of review policies, documentation standards and identified areas of improvement in clinical documentation.
Appeals Nurse - Remote
Toney Healthcare Consulting
Tampa, FL
12.2021 - 10.2022
- Processed and finalize appeals within agreed-upon turnaround time.
- Completed in-depth investigations pertaining to discipline and grievance management and recommended strategies.
- Provided expertise or general support to Denials Specialist staff in reviewing, researching and investigating medical necessity denials.
LPN
UMADAOP
Mansfield, OH
06.2021 - 10.2021
- Supported and assessed clients struggling with addiction or relationship issues and devised strategies based on client needs.
- Displayed sensitivity to cultural and linguistic needs of clients and families served.
LPN
Richland Correctional Institution
Mansfield, OH
02.2020 - 03.2021
- Met all relevant regulatory requirements, comprehended and complied with professional standards, internal policies and procedures.
- Remained proficient in time management, priority setting skills.
- Supported physicians during examinations to assist with diagnostic procedures.
LPN
Pharmaceutical Strategies C/o CVS Minute Clinic
Columbus, OH
09.2019 - 02.2020
- Consistently worked independently, multi-tasked, effectively presented information and responded to questions from families, members and providers.
- Monitored, tracked and conveyed important patient information to healthcare staff to help optimize treatment planning and care delivery.
- Found opportunities to improve the quality of care/services.
Nurse Consultant
Pharmeceutical Strategies C/o Pharmerica
Columbus, Ohio
04.2019 - 08.2019
- Maintained production and quality standards.
- Advocated areas for remediation opportunities based on audit outcomes.
- Collaborated with faculty staff to ensure medication accountability.
LPN Appeals Nurse
TotalMed Staffing C/o Buckeye Health Plan
Columbus, OH
08.2017 - 01.2018
- Offered expertise or general support to Denials Specialist staff in reviewing, researching, investigating, and resolving denials.
- Reviewed denials processes to promote consistency and accuracy within the processes and compliance with Medicare, NCQA, and HIPAA guidelines.
- Reviewed and audited all adverse decisions for members of the health plan while utilizing clinical expertise and specific tools to ensure compliance.
LPN Case Manager
Global Communication International c/o Defense Supply Center
Columbus, OH
04.2017 - 08.2017
- Completed clinical audits which focused on medical and behavioral health utilization denials.
- Demonstrated a current knowledge of medical and UM policies.
Pre Certification Nurse / LPN
Quantum Health
Columbus, OH
09.2016 - 02.2017
- Investigated questionable procedures and present Physician Peer Reviewer
- Evaluated and completed over 25 daily prior authorization requests for medical services.
- Identified potential high risk/high cost cases and chronic condition cases and refer to the appropriate case management team.
Utilization Management LPN
1-888-Ohiocomp
08.2015 - 02.2016
- Reviewed claims for worker's compensation.
- Implemented decisions to approved or denied per ODG.
- Trained new employees on guidelines, systems and job duties.
Prior Authorization LPN
Buckeye Health Plan
06.2014 - 08.2015
- Accomplished telephonic review of prior authorization requests.
- Completed medical necessity and level of care reviews for requested services using clinical judgment.
- Reviewed and administered audits on adverse decisions for members of health plan while utilizing clinical expertise.
Education
Sales Engineer
Careerist
01.2023
Diploma - Practical Nursing
Knox County Career Center
Mount VernonAssociate of Arts - Retail Management
Bradford School
Columbus, OHSkills
- Ability to explain healthcare terminology and products to non-healthcare audiences in a clear and concise manner
- CRM, AWS
- Collaborate with Interdisciplinary Team
- Proficient audit reviewer
- Presentation and technical demonstration
- Excellent verbal and written communication skills
Timeline
LPN Office Nurse
Avita Hospital
04.2024 - Present
Clinical Excellence Nurse
Centene Corporation
02.2023 - 09.2023
Appeals Nurse - Remote
Toney Healthcare Consulting
12.2021 - 10.2022
LPN
UMADAOP
06.2021 - 10.2021
LPN
Richland Correctional Institution
02.2020 - 03.2021
LPN
Pharmaceutical Strategies C/o CVS Minute Clinic
09.2019 - 02.2020
Nurse Consultant
Pharmeceutical Strategies C/o Pharmerica
04.2019 - 08.2019
LPN Appeals Nurse
TotalMed Staffing C/o Buckeye Health Plan
08.2017 - 01.2018
LPN Case Manager
Global Communication International c/o Defense Supply Center
04.2017 - 08.2017
Pre Certification Nurse / LPN
Quantum Health
09.2016 - 02.2017
Utilization Management LPN
1-888-Ohiocomp
08.2015 - 02.2016
Prior Authorization LPN
Buckeye Health Plan
06.2014 - 08.2015
Sales Engineer
Careerist
Diploma - Practical Nursing
Knox County Career Center
Associate of Arts - Retail Management
Bradford School
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