Kaylee Brown
Lakeland,FL
Summary
Passionate Nurse with 10+ years of experience in diverse healthcare settings. Driven by creative approaches to healthcare when traditional methods fails to meet a patients healthcare needs. Committed to patient advocacy, education and high-quality individualized care.
Overview
13
13
years of professional experience
Work History
PA1 UM Review Nurse
Centene
Tampa, FL
09.2019 - 01.2024
- Conducted utilization reviews, concurrent reviews, authorization requests and discharge planning. Adhered to the laws specific to Medicare, Medicaid (all compact states), and Obamacare (all compact states).
- Identified opportunities for improved quality of care through review of clinical documentation. Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries.
- Identified potential areas of fraud or abuse within the organization's operations and created reports that were submitted to compliance department.
- Performed quality assurance audits on completed utilization review cases for FL Medicaid teams to ensure compliance with company policies and AHCA state guidelines.
- Handled all responses to AHCA complaints regarding Utilization Management processes for FL Medicaid. Created and maintained the spreadsheet for tracking cases and responses.
- Applied medical criteria and clinical judgement to researched cases to evaluate and establish determinations.
- Collaborated with Provider Relations, Case Management, and Claims Department in group meetings to identify issues and find cost-effective solutions regarding member specific cases.
- Worked for Escalations, Auditing, Reporting and conducted reviews for all Lines of Business in all Markets.
Creative Arts Director
Crossroads Church
Prince George, VA
08.2016 - 03.2018
- Trained and oversaw 50+ volunteers for 3 services in 2 locations in areas related to Sunday Morning operations. I oversaw sound team, lighting team, worship team, greeting team, parking lot ministry, children's ministry, nursery, creative arts teams, transportation team and youth ministry.
- Developed and implemented children's curriculum and training manuals for all areas of oversight.
- Managed church rentals including 3 properties and 15 renters. Advertising the church property, showing it, drafting lease, collecting weekly rents, and responding to any renter complaints.
Nurse
Dominion Women's Health
Mechanicsville, VA
08.2012 - 08.2016
- Assessed patient physical condition by obtaining vital signs; assisted with in office surgery and procedures; triaged patient calls; trained all incoming nurses; documented patient encounters into EMR system, etc...
- Met with equipment representatives and drug reps for all new surgeries being implemented and learned how to utilize and perform medical procedures such as ablations, IUDs, HRT Pellet insertions, Hysteroscopy, D&C, etc...
- Responded to pregnant and menopausal patient concerns with tact, compassion and efficiency.
Customer Service Representative
Sweet Frog
Yorktown, VA
01.2012 - 08.2012
- Provided excellent customer service to ensure a positive experience for all guests.
- Performed opening and closing duties such as cleaning all machines, stocking, checking inventory, etc...
Store Manager
Bailey Island Tiffins
Bailey Island, Maine
06.2011 - 09.2011
- Conducted daily ice cream store operations, including opening and closing procedures, cash handling, inventory checks, training of new employees, proper sterilization of ice cream equipment, etc.
Education
MLO License - Mortgage Loan Origination
Mortgage Educators
01-2019
Ordination - Theology
Fountain of Salvation
Richmond, VA01-2014
LPN - Nursing
Portsmouth School of Practical Nursing
Portsmouth, VA01-2011
Local Ministers License - Leadership Training
Redemption School of Ministry
Prince George01-2011
High School Diploma -
Churchland High School
Portsmouth, VA01-2010
Skills
Improving customer and employee experience by recognizing organizational gaps and finding a solution At Centene I submitted an idea to the CEO of Sunshine FL Medicaid to improve there escalation process and they implemented it across then entire market I also helped create the tracking system used for all State Complaints that improves efficiency and consistency for patient concerns At Dominion Womens Health I created the training system for all incoming staff to enhance customer experience At Crossroads I rendered strategies that grew the volunteer base from 5 to 50 people in less than a year I also organized the rental process which increased our rentals from 60% to 100% capacity
Timeline
PA1 UM Review Nurse
Centene
09.2019 - 01.2024
Creative Arts Director
Crossroads Church
08.2016 - 03.2018
Nurse
Dominion Women's Health
08.2012 - 08.2016
Customer Service Representative
Sweet Frog
01.2012 - 08.2012
Store Manager
Bailey Island Tiffins
06.2011 - 09.2011
MLO License - Mortgage Loan Origination
Mortgage Educators
Ordination - Theology
Fountain of Salvation
LPN - Nursing
Portsmouth School of Practical Nursing
Local Ministers License - Leadership Training
Redemption School of Ministry
High School Diploma -
Churchland High School
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