Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Regina Brazel

Sulphur Springs,TX

Summary

Highly skilled Registered Nurse with 17+ years’ experience with the most recent care provided in Case Management. Obtained Certified Case Manager license. Established Certified Case Manager support including assessment, counseling, education regarding medications and disease processes, treatment, lab work, documentation of care plans, and administration of treatment procedures. Computer skilled, managing heavy daily patient volume including telephone triage, appointment scheduling, and patient referrals to other specialties. Proficient in all documentation, record maintenance and paper work to ensure accuracy and patient confidentiality.

Overview

19
19
years of professional experience
1
1
Certification

Work History

Preauthorization Specialist Registered Nurse

United Healthcare
01.2021 - Current
  • Followed all company policies and procedures to deliver quality work.
  • Improved customer satisfaction rates through proactive problem-solving and efficient complaint resolution.
  • Utilize knowledge of medical conditions and treatment options to determine if a service meets medical necessity criteria for prior authorization approval. communicate with healthcare providers regarding authorization status, providing clear explanations for approvals or denials and addressing any concerns.
  • Manage denied requests, including reviewing appeals, providing supporting documentation, and communicating with providers regarding potential solutions.

Registered Nurse, Certified Case Manager

City Hospital White Rock
02.2019 - 08.2023
  • Oversight of the clinical plan of care to conform to evidence-based practice and regulatory requirements
  • Medical necessity screening, care coordination, discharge planning, facilitation of multi-disciplinary patient care conferences, managing disputes and making referrals to other departments
  • Communication with patients and their families about the plan of care to including collaboration with physicians, office staff and ancillary departments such as pharmacy and lab
  • Insure accuracy of patient demographic and insurance information
  • Documentation of avoidable days and identifying and reporting over and under utilization
  • Remained PRN in ED until August 2023
  • Conducted thorough patient assessments to identify changes in condition, promptly notifying physicians and initiating appropriate interventions when necessary.
  • Utilized critical thinking skills to prioritize nursing interventions based on patients'' acuity levels and individual needs.

Registered Nurse, Certified Case Manager

GENEX Services LLC
09.2015 - 10.2018
  • Use clinical/nursing skills to help coordinate the individual’s treatment program while ensuring quality, cost-effective care
  • Serve as an intermediary to interpret and educate the individual on his/her disability, and the treatment plan established by the case manager, physicians, and therapists
  • Explains physician’s and therapists’ instructions, and answers any other questions the claimant may have to facilitate his/her return to work
  • Work with the physicians and therapists to set up medical assessments to develop an overall treatment plan that ensures cost containment while meeting state and other regulator’s guidelines
  • Researches alternative treatment programs such as pain clinics, home health care, and work hardening
  • Coordinates all aspects of the individual’s enrollment into the programs, and then monitors his/her progress, to ensure quality and cost-effectiveness of care and minimize time away from work
  • Works with employers on modifications to job duties based on medical limitations and the employee’s functional assessment
  • Helps employer rewrite a job description, when necessary and possible, to return the client to the workplace
  • Coordinates injured workers’ appointments and arranges and/or personally escorts him/her to the appointments
  • Maintain all case documents in files ensuring a comprehensive and detailed source of information for all parties involved in the case
  • Prepare detailed evaluation reports, as per account guidelines, and case recording documenting
  • Maintain phone contact with all parties involved, monitor, update, and advance case activity to ensure the progress of the case
  • Complete insurance carrier reports on a monthly (or as required) basis, as well as other necessary paperwork for the insurance company, state, or other regulatory bodies
  • Maintain professionalism always despite the stressful demands of the position
  • Capable of maintaining close relationships among all parties involved both in person and over the phone
  • Acquire and maintain knowledge of developments in the medical case management field
  • Assists in training/orientation of new staff as requested
  • Monitor functions assigned to non-case managers and provides input on the performance of support staff to their supervisor

Registered Nurse, Case Manager

Optum Healthcare
07.2012 - 06.2015
  • Assess and interprets customer needs, gaps, and requirements, identifies solutions to non-standard request and problems, solves moderately complex problems and/ or conducts moderately complex analyses, develops care plan in collaboration, with consumer/caregiver/provider, works with minimal guidance, seeks guidance on only the most complex tasks, translates concepts into practice, provides explanations and information to others on difficult issues, coaches, provides feedback, and guides others, collaborates with specialists, physicians, and medical directors to provide the necessary care and cost efficient care for the customer, assesses the effectiveness and quality of services provided related to clinical, functional, and financial impact and outcomes, improving unhealthy lifestyles and sustaining healthy behaviors for our consumers, maximizes use of community services, support programs, and resources available to customer, educates and supports consumers treatment to assist them in the best decision making for their health and wellness, takes in-bound calls and places out-bound calls as dictated by consumer and business needs, act as a resource for others with less experience, department specifics may vary including onsite case management working within the hospital system for ongoing clinical support during inpatient care as well as post discharge collaborating with hospital social worker, patient and family

Registered Nurse

Trailblazer, LLC
11.2012 - 06.2012
  • Medical review for Medicare part A predeterminations for payment of Medicare inpatient and hospital service claims
  • Utilization of local and national coverage determination requirements for Medicare and Medicade
  • Determined decision for denial or payment of Medicare claims based on the Local and National Coverage determination requirements
  • Planned and prepared letters for the providers and/or beneficiaries based on the decision of payment or denial of Medicare claims

Registered Nurse

UT Southwestern
09.2008 - 12.2011
  • Assessment of patients and documentation of patient histories
  • Managed triage calls by obtaining critical information and collaborating between physicians to determine necessary care
  • Oversaw the care of patients during clinic visits
  • Educated patients on disease processes that included but were not limited to diabetes, thyroid disorders, pulmonary disorders and several types of cancer
  • Administered chemotherapy infusions once per week to patients with Rheumatoid Arthritis, Crohn's disease and several types of lymphomas
  • Educated patients on medication administration and the importance of adherence, follow up, side effects, and importance of each medication in regards to the patients health
  • Evaluated health education needs of patients and provided necessary training and instruction
  • Acted as a liaison between patients and physicians to ensure patient comprehension of any and all treatment plans
  • (remained PRN until June of2011)

Registered Nurse

Advanced Vascular and Vein Center
06.2011 - 09.2011
  • Implemented pre and post-operative care for patients having in office vascular surgery
  • Accurately documented all elements of nursing assessments, treatments, medications, discharge instructions, and follow up care
  • Evaluated patient labs prior to surgical procedure to insure proper functioning of kidneys and liver before surgical procedures
  • Administered IV normal saline prior to surgery through vascular access
  • Conducted immediate post operative assessments by assessing vital signs and patient’s surgical sights
  • Educated patient and family members of home care prior to discharge

Registered Nurse

Lake Pointe Medical Center
12.2007 - 09.2011
  • Lateral Transfer from Doctors Hospital, both are Tenet facilities
  • Managed up to4 patients at a time ranging from critically ill to minor injuries
  • Assessed patients and documented patient histories, prioritized treatment and maintained patient flow
  • Provided treatment within scope of practice as defined by state law
  • Coordinated with doctors and charge nurse to develop individualized plans of care for each patient
  • Started IV's, foley catheter's, drew blood, assisted physician with cardiac arrest patients and hemodynamically unstable patients, provided injections per physician orders, and skillfully performed suture removals for patients of all ages
  • Monitored patient reactions to drugs and carefully documented progress of individuals
  • Educated patient's with various disease processes on signs and symptoms, what to watch for, necessity of follow up care, wound care, and medication
  • Received a gold star, an award given monthly to the highest performing employee
  • Recognition of patient care and the ability to lead and motivate team members
  • (remained PRN until June2011)

Registered Nurse

Doctors Hospital White Rock Lake
06.2006 - 12.2007
  • Managed up to4 patients at a time ranging from critically ill to minor injuries
  • Assessed patients and documented patient histories, prioritized treatment and maintained patient flow
  • Provided treatment within scope of practice as defined by state law
  • Coordinated with doctors and charge nurse to develop individualized plans of care for each patient
  • Started IV's, foley catheter's, drew blood, assisted physician with cardiac arrest patients and hemodynamically unstable patients, provided injections per physician orders, and skillfully performed suture removals for patients of all ages
  • Monitored patient reactions to drugs and carefully documented progress of individuals
  • Educated patient's with various disease processes on signs and symptoms, what to watch for, necessity of follow up care, wound care, and medication

Education

Associate of Applied Science Degree - Nursing

Trinity Valley Community College
Athens, Texas
05-2007

Parkland Critical Nurse Residency
Dallas, Texas
02-2008

General Equivalency Diploma - undefined

Austin, Texas
01.1994

Skills

  • Medication and IV administration
  • Direct patient care
  • Documentation and charting
  • Patient assessment
  • Strong clinical judgment
  • Patient education and counseling
  • Patient and family advocacy

Certification

  • Registered Nurse - State of Texas
  • Certified Case Manager- National

Timeline

Preauthorization Specialist Registered Nurse

United Healthcare
01.2021 - Current

Registered Nurse, Certified Case Manager

City Hospital White Rock
02.2019 - 08.2023

Registered Nurse, Certified Case Manager

GENEX Services LLC
09.2015 - 10.2018

Registered Nurse

Trailblazer, LLC
11.2012 - 06.2012

Registered Nurse, Case Manager

Optum Healthcare
07.2012 - 06.2015

Registered Nurse

Advanced Vascular and Vein Center
06.2011 - 09.2011

Registered Nurse

UT Southwestern
09.2008 - 12.2011

Registered Nurse

Lake Pointe Medical Center
12.2007 - 09.2011

Registered Nurse

Doctors Hospital White Rock Lake
06.2006 - 12.2007

General Equivalency Diploma - undefined

Associate of Applied Science Degree - Nursing

Trinity Valley Community College

Parkland Critical Nurse Residency

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