Open To Work
Kimberly Brown
Milton,FL
Work Preference
Summary
Registered Nurse with extensive experience in utilization management and care coordination. Proficient in clinical documentation and ICD-10 coding, enhancing data accuracy and compliance. Demonstrates analytical thinking and problem-solving skills to optimize patient outcomes and improve organizational efficiency.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Remote RN Clinical Consultant Contractor
Judge Healthcare for Vatica Health
Wayne, Pennsylvania
01.2026 - 05.2026
- Executed comprehensive reviews of patient medical records, extracting critical clinical information.
- Entered essential data into technology platform, ensuring compliance with workflow guidelines.
- Conducted thorough chart reviews to identify and rectify missing or incomplete information, enhancing coding accuracy.
- Analyzed patient data for accurate risk adjustment coding, improving documentation quality.
- Reviewed medical records to identify and code diagnoses per ICD-10 guidelines.
- Maintained confidentiality of patient information in accordance with HIPAA regulations.
- Assisted physicians in identifying appropriate diagnosis codes based on medical record documentation.
- Navigated electronic medical records effectively, demonstrating adaptability to new tools.
Clinical Resources Nurse-RN (Permanent)
Western Health Advantage
Sacramento, CA
11.2020 - 11.2024
- Reported directly to Western Health Advantage's (WHA) Utilization Operations Director, ensuring effective utilization management review functions.
- Collaborated with member services, claims finance, and sales representatives to interpret benefits and facilitate transitions of care.
- Evaluated non-network emergency/urgent hospital admissions, coordinating appropriate service provision with stakeholders.
- Executed telephonic concurrent reviews for out-of-area admissions, enhancing care management assistance.
- Assisted member services representatives in interpreting benefits eligibility and compliance issues for timely access to care.
- Reviewed pre-service requests for financial risk verification, confirming medical necessity with contracted providers.
- Provided continuity of care screenings and assistance for new qualified members facing transition issues.
- Supported regulatory audits by preparing necessary documentation and conducting clinical chart abstractions.
Clinical Resources Nurse-RN (3-month Temporary assignment)
Aerotek Staffing for Western Health Advantage
Sacramento, CA
07.2020 - 10.2020
- Reported to WHA's Utilization Operations Director, collaborating with CMO and AMD for effective UM functions.
- Facilitated transitions of care by collaborating with member services, claims, finance, and sales teams.
- Conducted utilization reviews on non-network emergency admissions, ensuring appropriate service provision through stakeholder collaboration.
- Executed telephonic concurrent reviews for out-of-area hospital admissions, optimizing patient outcomes through care management assistance.
- Assisted member services in interpreting benefits and compliance issues to ensure timely access to care coordination.
- Reviewed pre-service requests for financial risk verification, confirming medical necessity with contracted providers.
- Provided continuity of care screenings and assistance for new members experiencing transition issues.
- Supported UOD in developing educational materials related to plan benefits and UM processes.
Outpatient Case Manager-RN
Southern California Physicians Managed Care Services
San Diego, CA
09.2019 - 06.2020
- Evaluated service setting appropriateness and health plan benefits for requested services with contracted providers.
- Reviewed referral requests from medical groups to verify compliance with health plan criteria.
- Assessed requests for urgent, routine, and retro cases within established time frames to meet legislative standards.
- Coordinated with health plans for timely processing of expedited appeals.
- Facilitated review of medical necessity denials by referring to physician reviewers for prompt resolution.
- Obtained necessary information for medical director's evaluation of appeals.
- Notified health plan representatives regarding potential transplants, second opinions, and investigational requests.
Utilization Management-RN
Insight Global Contract For PPMSI/HCA/Santa Clara County/Individual Practice Association (SCCIPA)
Foster City, CA
06.2018 - 01.2019
- Applied utilization management processes to ensure continuous care across healthcare continuum.
- Reviewed precertification requests for medical necessity in collaboration with medical director on complex cases.
- Gathered essential information from providers and facilities to support informed service approval decisions.
- Identified cost reduction opportunities while maintaining quality care and regulatory compliance.
Home Health Case Manager-RN
Sutter Care at Home
Roseville, CA
05.2017 - 03.2018
- Managed care for approximately 25 patients, achieving productivity standards in service delivery.
- Planned and organized all patient services to ensure high-quality care for caseload.
- Coordinated interdisciplinary teams to implement comprehensive care plans that improved patient outcomes.
- Assessed patient needs and facilitated access to resources, including advanced illness management programs.
- Communicated with physicians to secure orders and provide updates on patient status.
- Provided functional guidance to licensed vocational nurses, physical therapists, occupational therapists, speech-language pathologists, medical social workers, registered dietitians, and home health aides.
- Utilized Epic EMR system daily for documentation and patient-provider interactions.
- Managed visit utilization while effectively controlling expenses.
Home Health Case Manager-RN
Rideout Health
Marysville, CA
10.2016 - 05.2017
- Completed oasis information accurately and promptly, adhering to regulations and agency policies.
- Assessed patient conditions during home care visits and communicated updates to relevant parties.
- Developed and implemented individualized patient care plans, adjusting them based on changing needs.
- Ensured patient records reflected accurate care needs and conditions, improving patient management quality.
- Secured physician orders for changes, facilitating effective communication among staff for continuity of care.
- Collaborated with multidisciplinary teams to enhance patient outcomes and service delivery.
- Maintained clinical skills competency through ongoing education in IV techniques and chemotherapy certification.
- Organized case manager schedules in accordance with established care plans.
1 West (Medical-Surgical) Nurse-RN
Rideout Health
Marysville, CA
08.2015 - 10.2016
- Administered treatments, therapies, and medications per physician orders to ensure patient safety.
- Monitored vital signs and assessed patient conditions, notifying physicians of significant changes.
- Provided direct care for medical-surgical patients with diagnoses including heart failure and COPD.
- Completed thorough charting and communication to maintain continuity of care.
- Assisted patients with daily activities, promoting comfort and dignity.
- Advocated for patients with providers to secure optimal care and support.
- Performed wound care and managed G-tubes, NG tubes, and tracheostomies as needed.
- Ensured compliance with HIPAA regulations to protect patient data.
Pediatric/Adult Home Health-RN
Action Home Nursing Services
El Dorado Hills, CA
02.2015 - 08.2015
- Monitored blood sugar levels and supervised insulin administration for pediatric patients in schools.
- Delivered gastrostomy tube and oral feedings while ensuring cleanliness of feeding equipment.
- Administered medications via gastrostomy tube and orally, tracking schedules meticulously.
- Provided airway management through nebulizer and IPV treatments, performing suction as needed.
- Changed tracheostomy dressings and sanitized breathing equipment to maintain respiratory health.
- Assisted with hygiene care, including bathing, dental health, and dressing support for patients.
- Supervised activities and facilitated range of motion exercises to enhance patient mobility.
Family Practice Clinic Nurse-RN II
Trinity Hospital
Minot, North Dakota
01.2013 - 03.2014
- Assessed patient health risks and disease conditions for timely interventions and management.
- Administered, monitored, and documented prescribed medications accurately.
- Obtained vital signs and health history while updating patient medication lists.
- Triaged patients based on needs, scheduling appointments to optimize clinic flow.
- Performed medical treatments and interventions with precision.
- Prepared patients and assisted physicians during procedures and examinations.
- Collected laboratory specimens for analysis to support diagnostic accuracy.
- Educated patients and families with tailored materials for enhanced understanding of health conditions.
Charge Nurse-RN
Heritage Oaks Psychiatric Hospital
Sacramento, CA
01.2011 - 08.2011
- Administered medication and assessed effectiveness
- Conducted comprehensive admission assessments and interviews to establish individualized care plans
- Completed shift assessments of patients physical and mental status
- Oversaw and delegated tasks to unit staff (LVN, LPT, MHT) to ensure efficient workflow and patient care
- Communicated with patients, doctors, nurses and other staff
- Provided support and education to patients and their families
- Fostered an environment supporting patients' mental and emotional well-being through active engagement and support
- Delivered emergency medication in urgent scenarios
- Participated and intervened in code gray situations
Psychiatric Nurse Preceptorship
Sharp Mesa Vista Hospital
San Diego, CA
01.2010 - 04.2010
- Conducted psychiatric assessments to evaluate mental health needs of patients.
- Collaborated with interdisciplinary teams to create tailored treatment plans.
- Provided direct care to psychiatric patients in acute inpatient settings.
- Administered medications and monitored patient responses at Sharp Mesa Vista Hospital.
- Delivered emotional support to patients facing personal challenges or trauma.
- Assisted psychiatric registered nurse with essential nursing duties for four months.
Education
Bachelor of Science - Nursing
Point Loma Nazarene University
San Diego, CA05-2010
Associate of Art -
Sierra Community College
Rocklin, CA05-2005
Skills
- Clinical documentation
- Care coordination
- Patient Care
- Utilization review
- Case management
- Electronic health records
- ICD-10 coding
- Medical necessity review
- Risk assessment
- Utilization analysis
- Chart auditing
- Clinical research
- Discharge coordination
- IV medication administration
- Attention to detail
- Time management
- Problem solving skills
- Analytical thinking
- Critical thinking
- Effective communication
- Adaptability
- Versatility
- Logistical planning
- Deadline management
- Compliance auditing
- Data analysis
- Microsoft Word
- Patient Interaction
- Patient advocacy
- Regulatory compliance
- Risk coding
- Compliance auditing
- Utilization management
- Medical necessity determination
- Policy adherence
- Managed care
- Prior authorization
- Discharge planning coordination
- Milliman guidelines
- Communication
Certification
- Current Florida Registered Nursing License/Nursing Licensure Compact (NLC) number-RN9683784 Expiration Date: 4/30/2027
References
References/letters of recommendation available upon request.
Summary Of Core Abilities
- Attention to detail
- Problem solving skills
- Adaptability
- Versatility
- Critical thinking
- Time management
- Case management
- Clinical research
- Logistical planning
- Care coordination
- Utilization management
- Utilization review
Computer Programs Used
- EPIC
- CERNER
- PARAGON
- Office365
- Excel
- EZnet
- Salesforce
- Facets
- Ayin/CIM (for Medicare)
- MCG
Timeline
Remote RN Clinical Consultant Contractor
Judge Healthcare for Vatica Health
01.2026 - 05.2026
Clinical Resources Nurse-RN (Permanent)
Western Health Advantage
11.2020 - 11.2024
Clinical Resources Nurse-RN (3-month Temporary assignment)
Aerotek Staffing for Western Health Advantage
07.2020 - 10.2020
Outpatient Case Manager-RN
Southern California Physicians Managed Care Services
09.2019 - 06.2020
Utilization Management-RN
Insight Global Contract For PPMSI/HCA/Santa Clara County/Individual Practice Association (SCCIPA)
06.2018 - 01.2019
Home Health Case Manager-RN
Sutter Care at Home
05.2017 - 03.2018
Home Health Case Manager-RN
Rideout Health
10.2016 - 05.2017
1 West (Medical-Surgical) Nurse-RN
Rideout Health
08.2015 - 10.2016
Pediatric/Adult Home Health-RN
Action Home Nursing Services
02.2015 - 08.2015
Family Practice Clinic Nurse-RN II
Trinity Hospital
01.2013 - 03.2014
Charge Nurse-RN
Heritage Oaks Psychiatric Hospital
01.2011 - 08.2011
Psychiatric Nurse Preceptorship
Sharp Mesa Vista Hospital
01.2010 - 04.2010
Bachelor of Science - Nursing
Point Loma Nazarene University
Associate of Art -
Sierra Community College