MARSHA BROWN
Seminole,FL
Summary
Accomplished Registered Nurse with over 14 years of clinical experience and 8 years in nursing leadership, specializing in utilization management and quality improvement. Expertise in evaluating medical necessity and compliance with Medicare, Medicaid, and regulatory standards. Proven ability to analyze clinical data, identify documentation issues, and develop effective solutions in collaboration with interdisciplinary teams.
Overview
1
1
Certification
20
20
years of professional experience
Work History
Clinical Manager / QAPI Coordinator
ADVENTHEALTH HOME HEALTH
05.2025 - Current
- Provide clinical, quality, compliance, utilization, and reimbursement oversight for 20+ clinicians serving patients across six Florida counties within a high-volume home health environment.
- Conducted clinical and documentation audits to ensure medical necessity, utilization, plan of care integrity, OASIS accuracy, authorization compliance, and reimbursement documentation.
- Apply CMS, Medicare, Medicaid, payer, and regulatory requirements when evaluating clinical documentation, utilization, authorizations, medical necessity, and service delivery.
- Investigate denied claims and identify documentation, authorization, medical necessity, and utilization issues contributing to payment discrepancies.
- Analyze clinical documentation and supporting records to identify discrepancies, determine contributing factors, and support corrective action.
- Partnered with Finance, Billing, HIM, Coding, Compliance, Authorization, and Quality teams to address and resolve complex documentation, utilization, reimbursement, and compliance issues.
- Provide clinical guidance and education to clinicians regarding documentation requirements, utilization, regulatory expectations, and quality standards.
- Monitored quality and utilization trends, translating findings into specific process-improvement initiatives.
Patient Care Supervisor
BAYCARE HOMECARE
04.2024 - 05.2025
- Oversaw clinical operations, documentation compliance, quality performance, and staff accountability within a home health environment.
- Reviewed clinical documentation for accuracy, completeness, and compliance, ensuring high standards in service delivery.
- Implemented structured clinical audit processes that improved documentation compliance and OASIS accuracy.
- Analyzed trends in rehospitalization, infection control, and clinical performance to identify and prioritize improvement opportunities.
- Collaborated with clinical and operational stakeholders to address and resolve documentation, quality, and compliance issues effectively.
- Provided clinical guidance and accountability to staff while supporting consistent standards of patient care and documentation.
- Supervised patient care staff to ensure adherence to health standards.
Nurse Manager
EVARA HEALTH
06.2023 - 06.2024
- Directed clinical operations across eight outpatient clinic locations serving Pinellas County and approximately 65 team members.
- Ensured clinical quality, documentation compliance, and regulatory adherence while maintaining operational standards across multiple locations.
- Led workflow and process-improvement initiatives designed to improve operational efficiency and patient experience.
- Supported staff development and performance management through clinical problem-solving and interdisciplinary collaboration.
- Identified operational and clinical concerns, developing practical solutions to enhance consistency and quality.
Travel Registered Nurse
AYA HEALTHCARE / TRUSTED HEALTH
01.2020 - 01.2023
- Provided high-acuity nursing care across progressive care, respiratory, and COVID units within multiple hospital systems.
- Conducted comprehensive clinical assessments and applied clinical judgment to manage medically complex patients with changing conditions.
- Assessed disease processes, treatments, medications, interventions, and treatment responses to ensure safe, evidence-based care.
- Adapted to diverse organizational policies, clinical workflows, documentation standards, and electronic medical record systems.
- Utilized Epic, Cerner, and Meditech EMR platforms.
- Various Locations
PCU Charge RN / Research Coordinator
RIVERSIDE METHODIST HOSPITAL – OHIOHEALTH
01.2015 - 01.2021
- Oversaw clinical operations for 24-bed progressive care unit, supervising eight nurses to ensure high-quality patient care.
- Provided and coordinated care for medically complex patients requiring advanced assessment, clinical judgment, and understanding of disease progression and treatment.
- Evaluated patient conditions, treatment plans, medications, and clinical interventions while coordinating multidisciplinary care.
- Implemented evidence-based protocols for diabetic ketoacidosis and sepsis management.
- Coordinated neuroscience clinical trials, enhancing patient recruitment, ensuring protocol compliance, and streamlining clinical documentation and interdisciplinary communication.
- Served as a clinical resource and supported staff education, decision-making, and escalation of complex patient-care concerns.
Operating Room Charge RN / Unit Coordinator
NATIONWIDE CHILDREN'S HOSPITAL
01.2007 - 01.2015
- Coordinated clinical and operational activities across 13 operating rooms within a Level I trauma center.
- Facilitated accurate surgical documentation and interdisciplinary coordination to enhance procedural workflows and optimize supply utilization.
- Acted as a clinical resource for staff and coordinated complex operational needs within a high-acuity environment.
- Ensured documentation accuracy and resource utilization while prioritizing patient safety and compliance with regulatory requirements.
Education
Master of Science - Organizational Leadership
University of Denver
Denver03.2027
Bachelor of Science - Nursing
Chamberlain College of Nursing
Columbus, OH06.2013
Skills
- Utilization management
- Medical Necessity Review
- Clinical Documentation Review
- Authorization Review
- Concurrent Clinical Review
- Claims review
- OASIS accuracy
- Clinical Record Auditing
- Regulatory compliance
- Medicare compliance
- Managed Care Concepts
- Quality improvement
- Reimbursement Integrity
- Home health services
- Clinical Decision-Making
- Interdisciplinary Collaboration
- Clinical Root Cause
- Case analysis
- Electronic health records
- Microsoft Office / Excel
Certification
Registered Nurse: Florida — Unrestricted | Ohio, ACLS: American Heart Association, BLS: American Heart Association
Timeline
Clinical Manager / QAPI Coordinator
ADVENTHEALTH HOME HEALTH
05.2025 - Current
Patient Care Supervisor
BAYCARE HOMECARE
04.2024 - 05.2025
Nurse Manager
EVARA HEALTH
06.2023 - 06.2024
Travel Registered Nurse
AYA HEALTHCARE / TRUSTED HEALTH
01.2020 - 01.2023
PCU Charge RN / Research Coordinator
RIVERSIDE METHODIST HOSPITAL – OHIOHEALTH
01.2015 - 01.2021
Operating Room Charge RN / Unit Coordinator
NATIONWIDE CHILDREN'S HOSPITAL
01.2007 - 01.2015
Bachelor of Science - Nursing
Chamberlain College of Nursing
Master of Science - Organizational Leadership
University of Denver