Lindsay Brewer, RN, MSN, CMCN, CPC-A, CRC

Experience

• 

  DRISCOLL HEALTH PLAN

  Jan 2016 - Jan 2018

  Utilization Management, RN

  Utilization Review RN Case Manager specializing in acute inpatient/outpatient - adult, pediatric, and obstetric admissions including: home health, and durable medical equipment (DME) requests. Fluent in McKesson –Interqual criteria / Acuity Operating Systems. Frequently collaborated with Medical Directors and other members of the interdisciplinary team to ensure that patient needs are met. Worked in partnership with Quality and UR team to determine best practice and aid in implementation. Adhered to and maintain conscious knowledge of HEDIS / NCQA measures and various influencers. Show less

• 

  UnitedHealth Group

  Aug 2018 - now

  Performed clinical review of admissions a rehabilitation facility, LTAC or skilled nursing facility. Actively implemented a plan of care utilizing approved clinical guidelines to transition and provide continuity of care for members to an appropriate lower level of care in collaboration with the hospitals/physician team, acute or skilled facility staff, ambulatory care team, and the member and/or family/caregiver. Was responsible for coordinating the care from admission through discharge, and participated in integrated care team conferences to review clinical assessments, update care plans, identify members at risk for readmission and to finalize discharge plans. Show less

  • Director of Clinical Operations - Value Based Care

    Apr 2024 - now

  • Sr. Clinical Transformation Manager

    Jul 2021 - Apr 2024

  • Inpatient Care Manager - Registered Nurse

    Aug 2018 - Jul 2021
• 

  WellMed Medical Management

  Dec 2019 - Jul 2021

  Senior Clinical Coding Consultant - RN

  Collaborate to drive consistent, efficient processes and share best practices in a collaborative effort with Providers and Market Team, with a target to facilitate achievement of goals set for HCC Ratio, HCC Covered Ratio, and HCC Percent Covered. Drives Risk Adjustment improvement initiatives, develop recommendations for Risk Adjustment remediation plans and create tools and databases to capture relevant data for assigned markets to achieve corporate and market specific Risk Adjustment goals and initiatives. Works collaboratively with regional / market team and their leadership in a matrix relationship, and provides direction and guidance to Medical Coding Analysts, as well as cross functional team members within their respective Markets pertaining to Risk Adjustment. Show less