SHELLEY L. BROWN, OTR/L, CLT
MI
Summary
Experienced Utilization Review Coordinator with a focus on identifying and addressing potential overutilization of healthcare services, utilizing data analysis to drive quality improvements and cost containment initiatives. I am a results driven profession who works well in a multidisciplinary team to ensure appropriate care delivery while optimizing and promoting cost effectives and ensuring compliance with Medicare regulations.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Clinical Review Coordinator
Optum
01.2022 - Current
- Analyze clinical data for 200 + Medicare Advantage members each month delivering actionable insights that optimize care decisions and reduce unnecessary service
- Contributed to continuous improvement initiatives aimed at enhancing overall operational efficiency within the organization.
- Boosted department productivity by identifying bottlenecks and streamlining workflow processes for optimal efficiency.
- Review Oasis documentation/clinical notes and utilize InterQual along with CMS chapter 7 guidelines for appropriate authorization
- Ensure reporting/notification requirements are met as related to privacy and regulatory compliance
- Implemented and applied knowledge of HIPPA compliance, healthcare coding, and documentation
- Ensure patients medical need is clearly documented with supporting rationale noted in clinical impression
- Exceeding and maintaining productivity standards above 90%
- Maintained QAR of 100% for several consecutive months by utilizing and applying education, great attention to detail and application of work processes
- Demonstrated operational excellence and execution on Home Health KPIs
- Proven problem-solving and critical thinking skills using evidence-based practice
- Proven ability to work in fast paced, continually evolving work environment
- Proficiency with MS work, MS excel and MS PowerPoint
- Handled escalated calls efficiently, finding satisfactory resolutions for both providers and the company alike.
Occupational Therapist
RIVETUS REHABILITATION
01.2019 - 01.2022
- Hands on experience in treating patients with wide range of diagnosis including CVA, spinal cord, TBI, cardiac rehab and orthopedic surgeries
- Interpretation of data after analyzing test results, using evidence-based research and other clinical data to inform treatment decisions
- Supervised, reviewed, instructed and assigned the work of 5 COTAs
- Evaluating treatment effectiveness by monitor patients progress and adjusting treatment plans based on data analysis
- Strong understanding of medical knowledge including disease process, anatomy and physiology
- Effectively build positive working relations with caregivers, patients, interdisciplinary team to effectively coordinate patient care
Occupational Therapist
HOPE AT HOME
01.2016 - 01.2018
- Provided interventions and treatments to improve patient abilities to perform daily activities, manage symptoms and prevent injury.
- Collaborated with interdisciplinary team members for comprehensive patient care and optimal results.
- Participated in continuing education opportunities to stay current with industry trends and best practices in occupational therapy.
- Provided education to empower patients and families to understand conditions, treatments and treatment options for managing symptoms.
- Improved patient outcomes by implementing individualized treatment plans and monitoring progress.
- Adapted environments by making changes to patient homes, workplaces and school environments to promote safety, independence and participation.
- Streamlined documentation processes, ensuring accurate and timely records while maintaining patient confidentiality.
Occupational Therapist
Trinity at Home
06.2015 - 08.2016
- Provided interventions and treatments to improve patient abilities to perform daily activities, manage symptoms and prevent injury.
- Collaborated with interdisciplinary team members for comprehensive patient care and optimal results.
- Enhanced overall quality of life for patients with chronic conditions by addressing physical, cognitive, psychosocial, and sensory impairments.
- Established compassionate and caring relationships with patients.
- Meticulously reviewed records and referrals to determine and implement best treatment methods.
- Reduced hospital readmission rates by providing thorough post-discharge follow-up care and education.
- Facilitated patient independence in daily living activities, employing adaptive equipment and environmental modifications.
Occupational Therapist
TRINTY HOME CARE
01.2015 - 01.2016
Education
Masters of OT -
Baker College
BA - Health Promotion
Central Michigan University
Skills
- Critical thinking
- Adaptability
- Organizational growth
- Interdisciplinary collaboration
- Troubleshooting abilities
- Customer service expertise
- Analytical reasoning
- Data analysis
- Conflict resolution techniques
- Regulatory compliance
- Healthcare industry experience
- Strong communication skills
Certification
Medicare & Retirement, 2024;
Klose: Certified Complete Decongestive Therapy (CDT), 2019
Timeline
Clinical Review Coordinator
Optum
01.2022 - Current
Occupational Therapist
RIVETUS REHABILITATION
01.2019 - 01.2022
Occupational Therapist
HOPE AT HOME
01.2016 - 01.2018
Occupational Therapist
Trinity at Home
06.2015 - 08.2016
Occupational Therapist
TRINTY HOME CARE
01.2015 - 01.2016
Masters of OT -
Baker College
BA - Health Promotion
Central Michigan University
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