KYLIE B. LOWERY
Evolent Health
JACKSONVILLE,FL
1
Certification
10
years of professional experience
Detail-oriented Clinical Reviewer with extensive experience in healthcare evaluation. Expertise in assessing medical documentation and ensuring regulatory compliance while delivering accurate analyses. Committed to fostering team collaboration and adaptability to achieve reliable results in fast-paced environments.
Work History
Clinical Reviewer - Speech Language Pathology
3 Years 8 Months- Conduct comprehensive clinical reviews of speech-language pathology documentation to determine medical necessity, appropriateness of care, and compliance with payer, regulatory, and organizational guidelines.
- Apply advanced clinical expertise in speech, language, cognitive, and swallowing disorders to evaluate treatment plans, progress notes, assessments, and authorization requests.
- Process high-volume case reviews efficiently while maintaining exceptional accuracy, timeliness, and adherence to established turnaround standards.
- Demonstrate strong attention to detail in analyzing clinical documentation, identifying incomplete or inconsistent information, and ensuring thorough, evidence-based determinations.
- Collaborate with providers, interdisciplinary teams, and case managers to obtain clarifying documentation and support continuity of care.
- Interpret medical records, therapist evaluations, and plan of care documentation to support appropriate utilization review and reimbursement decisions.
- Ensure compliance with Medicare, Medicaid, commercial insurance criteria, and internal quality standards during review of cases.
- Communicate review outcomes clearly and professionally, providing concise clinical rationale for approvals, modifications, or denials as needed.
- Support quality improvement initiatives by identifying documentation trends, recommending process enhancements, and promoting best practices in clinical review workflows.
- Leverage strong organizational skills and sound clinical judgment to balance productivity expectations with high-quality, detail-oriented case evaluation.
Speech Language Pathologist Lead Therapist
2 Years 2 Months- Evaluate and treat children diagnosed with Autism Spectrum Disorder, Down Syndrome, Cognitive Deficits, Childhood Apraxia of Speech, Feeding/Swallowing Disorders, Dyslexia/Reading impairments and Articulation and Phonological Processing Disorders
- Tailor all assessment, treatment, and plans of care to age and functional status of each patient served
- Manage caseload of 50+ patients age 18 months – 18 years with speech and language diagnoses of development and acquired etiologies
- Discuss progress and suggest carryover to parents/caregivers to facilitate optimal success
- Maintain updated documentation necessary for insurance authorization
- Collaborate with Occupational Therapy and Physical Therapy to regularly evaluate effects of treatment and adjust to maximum benefit
- Complete daily Lead Therapist duties; maintain adequate clinical supplies, ensure high quality clinical care by reviewing and researching concerns or complaints and recommending corrective action as appropriate, orient and train new clinicians
- Assist in orientation and supervision of graduate student clinicians
Speech Language Pathologist
4 Years 4 Months- Conducted precise assessments to determine conditions and functional abilities in Intensive Care Unit and step-down floors in geriatric, adult and pediatric populations
- Active in Performance and Quality Improvement clinical group
- Proficient in evaluation and treatment of dysphagia, ventilation management, speech and language impairments as result of CVA and/or Traumatic Brain Injury/neurological population with diverse Ranchos Los Amigos Scale knowledge
- Interpreted results and developed Plan of Care (POC) for each individual patient including short and long-term goals, therapy frequency, and duration to restore, maintain and improve communicative functioning across variety of settings
- Monitored patients' respiratory status and ventilator operation and made adjustments during in-line Passy Muir Valve placement with Respiratory Therapist
- Delivered outstanding patient care in critical care units, including Pediatric Intensive Care Unit and Neonatal Intensive Care Unit
- Collaborated with multidisciplinary teams to facilitate client care and reduce case management barriers.
- Active participant in multidisciplinary rounds with Level I Trauma Team to determine patient readiness for post-acute intervention
- Achieved documentation productivity standards of >90% on a monthly basis
- Maintained productivity care standards of >75% on a daily basis
- Performed follow-up care and treatment at post-acute Skilled Nursing Facility
- Initiated communication and consultation with physicians and other family members and medical team to ensure coordination of treatment efforts and delivery of patient and family centered care
- Extensive experience with conducting bedside swallow evaluations and instrumental assessments such as Videofluoroscopic Swallow Study (VFSS) and Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in adult and NICU populations
- Lead role in Traumatic Brain Injury pilot study for performance and quality improvement
- Lead role in development of in-line Passy Muir Valve protocol for medical facility
- Presentation of in-service for inline Passy Muir Valve implementation to Trauma and Medical teams
- Assisted in orientation and supervision of graduate student clinicians
Education
Master of Science - Speech Language Pathology
Bachelor of Science - Human Development And Family Studies
- summa cum laude graduate
Skills
Clinical assessment
Task prioritization
Analytical thinking
Compliance management
Data entry
Teamwork and collaboration
Attention to detail
Detail-oriented
Claims processing
Certification
- American Speech-Language-Hearing Association - Certificate of Clinical Competence #14109154
- Licensed Speech Language Pathologist - State of Florida #SA 15424
Timeline
Clinical Reviewer - Speech Language Pathology
Evolent Health
12.2022 - CurrentRead More
Speech Language Pathologist Lead Therapist
Pediatric Therapy Associates
10.2020 - 12.2022Read More
Speech Language Pathologist
University Of Florida Health Level I Trauma Center
06.2016 - 10.2020Read More
Jacksonville University
Master of Science from Speech Language Pathology
Read More
Auburn University
Bachelor of Science from Human Development And Family Studies
Read More