LPN - Utilization & Authorization Specialist

MELISSA BROWN, LPN

Lauderdale Lakes, FL ***** • 954-***-**** • **************@*****.***

PROFESSIONAL SUMMARY

Licensed Practical Nurse (LPN) with over 17 years of clinical experience across home health, LTC, SNF, and acute care settings. Seeking to leverage expertise in utilization processes and medical necessity determination to support the Medical Management/Health Services team. Proven strengths in prior authorization support, clinical information collection and documentation, interdepartmental coordination, and applying national standards and regulatory guidelines to service requests. Possesses an active Florida LPN license and is fully remote-ready.

KEY COMPETENCIES

Prior Authorization Review: Analyzes authorization requests to determine medical necessity of service and appropriate level of care.

Regulatory Compliance: Applies national standards, contractual requirements, and regulatory guidelines to clinical reviews.

Utilization Management (UM) Support: Coordinates with healthcare providers and the authorization team to ensure timely review of services and promotes quality and cost-effectiveness of medical care.

Interdepartmental Coordination: Coordinates with healthcare providers and interdepartmental teams to assess medical necessity of care.

Clinical Documentation: Collects, documents, and maintains all member’s clinical information in health management systems to ensure compliance.

Escalation & Resolution: Escalates prior authorization requests to Medical Directors as appropriate to determine appropriateness of care.

Discharge Planning Support: Assists with service authorization requests for a member’s transfer or discharge plans to ensure a timely discharge between levels of care.

PROFESSIONAL EXPERIENCE

FIRSTAT Nursing — Tamarac, FL Quality Improvement Nurse - 08/2017–Present

Audited patient charts end-to-end to verify completeness, accuracy, and compliance for review readiness.

Validated OASIS and non-OASIS elements against the plan of care to uphold

documentation integrity.

Finalized discharge files/cases promptly to ensure timely, compliant close-outs and supporting utilization processes.

Alternative Home Health Care — Tamarac, FL Nursing Coordinator - 06/2015–08/2017

Orchestrated new-client admissions, assembling complete intake packets to support appropriate services and level of care determination.

Administered monthly and annual insurance recertifications for private and third-party payers, maintaining audit-ready records.

Streamlined employee scheduling and clinician coverage to meet visit timelines and staffing needs.

Reputable Healthcare — Davie, FL Licensed Practical Nurse - 06/2014–06/2015

Administered medications and monitored for adverse reactions, documenting per protocol.

Executed wound-care treatments and reinforced unit quality controls.

Completed patient documentation and ancillary duties with accuracy and timeliness.

Heritage Park East — Delray Beach, FL LPN / Charge Nurse - 08/2009–10/2012

Supervised day-shift nursing operations and directed daily staff support.

Ensured appropriate staffing levels to meet patient-care demands.

Enforced quality standards, assisted with clinical education, and verified documentation accuracy.

Colonial Inn — Delray Beach, FL LPN -12/2000–08/2009

Directed a 30-member nursing team, building schedules and coverage plans to maintain resident care.

Administered medications and delivered wound care while monitoring for safety and side effects.

Oversaw unit quality control and documentation practices.

EDUCATION & CERTIFICATIONS

Associate of Science in Nursing (ASN) - Techni Pro Institute, Boca Raton, FL

Licensed Practical Nurse (LPN) - Atlantic Vocational Center, Coconut Creek, FL

IV Certification

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