Caroline Johnson
Inglewood,CA
Summary
Highly qualified RN with broad experience in critical care, patient education, and team leadership. Specialized skills include acute patient care, health assessments, and medical documentation. Notable strengths: superior communication abilities, strong clinical judgment, and a commitment to fostering collaborative relationships within healthcare teams. Past work highlights include implementing quality improvement initiatives that enhanced patient satisfaction and reduced readmission rates.
Overview
11
11
years of professional experience
Work History
RN Case Manager-Appeals -Quality Review
St. Francis Medical Center-Lynwood, CA
Los Angeles , CA
2013.06 - Current
- Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
- Actively participated in multidisciplinary team meetings with the Chief Financial Officer and Medical Director, discussing complex cases retrospectively and concurrently, With members of the healthcare team and finance team.
- Ensured compliance with regulatory standards concerning utilization review, ethical decision making and legal aspects of case management practice.
- Interpreted and evaluated diagnostic tests to identify and assess patient's condition.
- Analyzed financial information related to insurance coverage eligibility prior to initiating services.
- Attended continuing education seminars relevant to case management practices.
- Evaluated transitions between levels of care through effective retrospective reviews of all medical records provided during each admission
- Retro reviews to assess patient's physical, mental, and psychosocial health status influencing Length of stay and levels of care
Education
Bachelor of Science - Registered Nursing
University of Phoenix
Gardena, CA2006-01
Skills
- Discharge Planning
- Insurance knowledge
- Quality Improvement
- HIPAA Compliance
- Community Resources
- Medical Records Review
- ICDM Coding
- Professional and institutional Claims Review
- Retrospective and Concurrent
- Utilization review
- Medication Management review
- Healthcare regulations
- Case Management
- Student Precepting
- Documentation
- Wrote demand for reimbursement to diverse insurance companies
Languages
Spanish for Healthcare Professionals
Professional
English
Full Professional
Timeline
RN Case Manager-Appeals -Quality Review
St. Francis Medical Center-Lynwood, CA
2013.06 - Current
Bachelor of Science - Registered Nursing
University of Phoenix
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