Brandy Mcgrath Email & Phone Number

Atlanta, Georgia, Us

Bloomington, Minnesota, Us

• Responsible for leading and managing a team of 60+ supervisors, employees and contractors. Team titles included provider disputes supervisors, team leads, intake coordinators and analysts. The team scope consisted of working all assigned appeals, grievances, CTMs, provider payment disputes and intake across both teams.• Assisted in new platform/CRM development of Panorama using Dynamics 365 along with platform developers. This required providing business requirements, turn around time regulations, escalating any system bugs, assisting in providing resources to do user acceptance testing and continual follow up reporting for any issues that arise as well as participating in the follow-up sprints to enhance the platform for functionality and performance.• Provided necessary employee coaching and performance management to ensure team success and accountability. Participated in team interviews for new hires, regardless of position and title.• Worked in coordination with various internal and external business partners to ensure any escalations were handled timely and efficiently to deadlines were met. Business relationships include working with delegated vendors, claims team, analytics, compliance, human resources, utilization management, senior leadership, auditors and temporary agencies for staffing concerns, etc.• Served as the primary point person for all CMS audits and annual reporting. I would validate all universe submissions, data points, create case files for audit presentations as well as lead the audit in close collaboration with our compliance team. This included all Medicare audits: Annual Reporting, Timeliness Monitoring, ODAG Audits, etc.• Provided monthly reporting and incident disclosure to the CMS manager assigned to our organization.• Worked closely in conjunction with the provider disputes supervisors on escalated disputes cases, any special projects, personnel issues, etc.

Clearwater, Florida, Us

• Provides routine care to both postpartum couplets and gynecological surgical patients. Main patient load consists of mom and baby/babies couplet care, both vaginal and c-sections.• Preceptor for nursing students, new hires, and new graduate nurses to the policies and procedures of our unit.

Tampa, Fl, Us

• Responsible for leading and managing a team of 27 employees ranging from Clinical Support Associates, Appeals Coordinators, Appeals Clinicians and Medical UM Clinicians responsible for UM activities for approximately 60,000 members.• The Outpatient team I lead was responsible for completing out-of-network redirection to in-network providers and facilities per client guidelines.• Managed the clinical team effectively to reduce our average TAT from 12 days for pre-service standard authorizations to consistently under 4 days.• Facilitated in new hire training on client specific materials, proper use of MCG and medical necessity hierarchy criteria, job aid/quick reference guide creation for any process changes.• Participated in NCQA, URAC and CMS audits from an operational perspective presenting case files to the auditors and clients both in person and via Webex.• Primary contact for any client escalation issues needing immediate resolution, also one of the primary contacts for our clients’ senior leadership to reach out to for concerns.• Participated in configuration and UAT for new medical management platform (CareRadius) as well as assisting during new client and market implementation/go-live.• Responsible for interviewing, hiring, and performance management/coaching for my team.

Tampa, Fl, Us

• Reviewed authorization requests needing to possibly be sent for Medical Director Review at an escalation level looking at benefit coverage and exclusions and that medical necessity criteria were properly applied.• Worked authorizations for members part of Tricare, Medicare Advantage and Commercial Individual and Family Plans. • Familiar with CMS guidelines (NCDs and LCDs) as well as MCG Criteria utilizing CareWebQI and InterQual.• Maintained contact with clients to ensure any issues or member needs were addressed timely and accordingly• Ensured that TATs were being met on authorizations according to request type, regulatory guidelines and client specific guidelines.

Tampa, Fl, Us

• Compliance auditor ensuring CMS, NCQA and URAC guidelines were met for SNP, CM, and UM products.• Developed an audit tool for our Multichronic Care Management (MCCM) program.• Participated in preparing case files for CMS, NCQA and URAC accreditation audits.

St. Petersburg, Florida, Us

• Daily clinical reviews and audits of patient charts in multiple EMR systems (AllScripts and e Clinical Works)• Noted any and all findings that were missing in a comprehensive Excel spreadsheet to aid centers in providing comprehensive patient care• Findings consisted of operational items as well as diagnoses/potential diagnoses that were not evaluated properly or missing all together• Audits included thoroughly reviewing patient’s past medical records, lab results, consults, Hospital/ER records, office visit notes and any additional nurse notes to ensure everything was properly documented/captured for billing purposes• Regular meetings with Medical Directors to ensure new changes were rolled out, provide clarification on our teams’ role within the organization• Received a JSA Healthcare Service Excellence Award for our national initiative “Ride The Wave” as I facilitated the Florida market in 2016 in making sure 95% of our Medicare Advantage patients were seen within a JSA facility during the calendar year

• Served as relief charge nurse on a 28-bed postpartum mom/baby and GYN surgical unit. Responsibilities including managing the workflow of all nurses and techs, aiding the team with any emergent issues that arise, creating assignments for the oncoming shift, and reporting to administrator on duty any unit changes.• Provides routine care to both postpartum couplets and gynecological surgical patients. Main patient load consists of mom and baby/babies couplet care, both vaginal and c-sections.• Aided upper management in creating a new report sheet that is now being used hospital wide for shift to shift report hand-off.• Preceptor for nursing students, new hires, and new graduate nurses to the policies and procedures of our unit.

Tampa, Fl, Us

• Provided appropriate assessment and nursing care to surgical and oncology patients. Surgical patients to include: pre and post whipple patients, bowel resections, laparoscopic and open cholecystectomy, limb amputations and more. Non-surgical patients to include: exacerbation of COPD and asthma, small bowel obstructions, mental illness and patient’s receiving end of life care.• Provides support to both patients and their families during times of crisis when new diagnoses are received.• Familiar with working with the following devices: PICC lines, central lines, nasogastric tubes, chest tubes, wound vacuums, telemetry monitoring, colostomy bags and various drains (JP, accordion, biliary, nephrostomy, etc.).

Tampa, Fl, Us

• Responsible for timely completing and documenting client’s vital signs, blood glucose levels and daily weights.• Provided nurses with appropriate updates to critical changes in vital signs and any abnormal client findings during hourly rounding.• Completes routing lab draws and proper record keeping of intake and output for each client assigned.• Facilitated client’s as necessary with positioning, ambulating and personal hygiene needs.

New York, New York, Us

North America Contract Administrator (Temporary Position Turned Permanent)• Responsible for contract review to ensure that all necessary items are compliant for audit purposes.• Responsible for tracking contracts to secure internal signatures for final execution once signed contracts are returned from suppliers. • Scan and enter all contracts into centralized database, assign contract to appropriate sourcing manager, and store original contracts according to Citi policy.• Maintain constant communication with the sourcing and contract managers to inform them of contract status and location as needed.Regional Contracts Analyst (Temporary Position)• Responsible for reviewing all of the contracts that were transferred to the Tampa, FL offices from the Northeast Region to ensure that they were compliant with Citi Contract Guidelines.• Created a tracking method for upper-level management to review the contracts that were received and the status of them.• Uploaded all contracts to an online database for quick reference by authorized users in the company.• Heavy Excel usage to monitor the progress of this project and to provide Citi management with an estimated time of completion for each step involved in the contract transition process.

Glendale, Ca, Us

Supported 1 Regional Manager plus 17 other managers. Assisted in the coordinating and scheduling of semi-annual manager meetings as well as all PowerPoint presentations that went with them. Assisted in weekly and monthly conference calls with the Regional Manager and Divisional Vice President. Handled and tracked all time off requests, once approved, was in communication to HR to have them finalized in the system. Prepared and drafted offer letters, written memos and warnings, and regional e-mails. Prepared weekly spreadsheets for the region as well as the regional office to show weekly numbers, profits, etc.Client Services Manager for FL and GAHandled all National Account compliance for Florida and Georgia when the clients use Vendor Management Systems (VMS) which included applicant submission to orders, client and Managed Service Provider (MSP) contact, contract auditing as needed, timecard and billing auditing, and correcting discrepancies as needed. Familiar with Vendor Management Systems such as: Beeline, Fieldglass, Taleo, Click Commerce, Elance, Peopleclick, Agile1, etc. Assisted in training on the corporate and field level for new Account Executives on client VMS policies and procedures. Maintained a solid working knowledge of all client accounts assigned and what their contract requirement and details were including but not limited to background compliance and proper Service Level Agreement requirements. Served as the liaison with client representatives, field personnel and corporate partners for performance related issues to ensure contractual compliance for all locations' account services. Identify problems and recommend solutions to all parties; i.e. clients, field personnel & corporate partners. Maintained accurate records order fulfillment activity on a quarterly basis, as well as reviewing and analyzing all client billing amounts and preparing quarterly reports for the corporate offices.

Glendale, Ca, Us

Managed day-to-day schedule for one Branch Manager and four Account Executives. Greet all visitors and applicants as well as screen all incoming phone calls. Managed payroll and insured processing accuracy for a growing branch. Ensured ISO compliance for all applicants registered in the branch as well as I-9 verification on all temporary associates. All general office duties as needed including: creating Excel trackers, Word documents for monthly temporary drawings and contests, copying, filing, scanning, supply ordering and maintenance, preparing UPS shipments and pickups, etc.Programs Used: MS Excel, MS Word, MS Outlook, MS Access, Various VMS for Payroll Processing

Associate'S Degree, Registered Nursing/Registered Nurse

Bachelor Of Business Administration - Bba, Business Administration And Management, General

Bachelor'S Degree, Business Administration And Management, General