Gina Johnson BSN, RN
Amelia,OH
Summary
Highly energetic and motivational nurse with more than 25 years clinical and management experience in Utilization Management, Quality Improvement, Hospice/Home Health RN Clinical Management , Skilled Nursing DON and HEDIS Nursing as Abstractor/Over-reader. Extensive EMR knowledge and well versed in CORE and HEDIS measures. Talented Manager with expert team planning and organizational skills to develop, build-up and coach to improve team's performance.
Overview
25
25
years of professional experience
1
1
Certification
Work History
Quality Review & Audit Lead Representative
CIGNA Healthcare
01.2023 - Current
- *Independent review and audit pertinent medical records information in accordance with multiple study criteria in alignment with HEDIS specifications
- *Work in partnership with Medicare Quality, Stars, Network Operations, and PQ4 Enhanced Care Coordinators
- *Identify gaps in documentation to share back to providers and market staff for future improvement of HEDIS rates
- *Serve as member of HEDIS MRR abstraction/over-read team
- *Ongoing collaboration gleaning records for additional information, utilization research applying measure probability logic to create additional HEDIS chase pursuits, and HEDIS MRR measure team
- *Advanced knowledge/capability utilizing various EMR software systems., Inovalon, QSHR, Epic, PCC, Cotiviti
- *Advanced level experience working with Microsoft Office Products, Excel, Power Point
RN Over Reader Nurse/NYIA ASSESSOR **SEASONAL
Total Med/ADDUS
01.2012 - 01.2023
- Contracts include large managed care companies. As HEDIS abstractor organize patient records and identify data within these files that are pertinent to HEDIS measures. Highly versed in Hybrid HEDIS Measures, LTSS measures, GWTG, CARE, SEPSIS and CANCER Registries. As HEDIS Over-reader responsibility include verifying data compiled by abstractor is accurate as per specific measures specs. HEDIS abstraction productivity averages 45-75 charts per day and Over read ability >75 charts per day while maintaining >95% accuracy. Specific measures include COL, CBP, CDC, IMA, PPC, COA, TRC, LSC, ABA, CIS, CCS, WCC, PPC and LTSS measures.
- FIDELIS CARE HEDIS OVER READ/2nd REVIEW NURSE Jan 2017-May 2023 contract position
- MOLINA HEDIS ABSTRACTOR/OVER READ/2nd Review Nurse Jan 2014-May 2016 contract position
- BAYHEALTH HEDIS ABSTRACTOR Jan 2012-May 2013
- NYIA UAS assessor; complete tele-remote UAS assessments contractual role to determine patient eligibility for Long Term Care services
RN Clinical Team Manager
Queen City Hospice
12.2017 - 01.2022
- As RN Clinical Team Manager oversee and support a Interdisciplinary Team of 40-50 FTE healthcare workers including RNs, Chaplains, Social Workers, Volunteers, Activities, and Volunteers.
- Led team to achieve 2 deficiency free JCAHO (Joint Commission Surveys)
- Ongoing collaboration with direct hospice physicians, nurse practitioners and contracted vendors as SNF, IL/AL, and Hospitals regarding everchanging needs of patients
- Ongoing documentation review with emphasis on New Admissions, Re-certifications, Discharge for cause/extended prognosis
- Develop and plan strategies to manage program growth and ensure program sustainability
- Manage all patient care aspects, improving functionality and cost-efficiency, and maximizing customer satisfaction
Home Health Nurse/Float Floor Nurse/Utilization Review Nurse
Brown County Regional Hospital
05.2007 - 12.2017
- Provided physical assessments, medication and acute disease management to hospitalized patients.
- Advised and coached patients progressing from hospitals, rehab facilities and other medical organizations to at-home treatment settings.
- Worked with multidisciplinary team to carry out successful treatment plans for diverse acute and chronic conditions.
- Actively participated in unit based Quality Assurance Program
- Reported findings to quality departments after conducting routine restraint audits and worked with team to devise corrective actions for deficiencies.
- Investigated and resolved issues affecting hospital operations and patient care.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Supervised and maintained all utilization review documentation through InterQual & Milliman
DIRECTOR OF NURSING, MDS COORDINATOR
Batavia Nursing Care Center
12.1998 - 05.2007
- MDS 3.0 completed and submitted all required assessments within guidelines and timeframe established by CMS
- Complete Raps and Triggers for all comprehensive MDS's
- Communicate status of MDS with other disciplines on daily basis
- Understanding entire RAI process and its correlating effect on quality measures, then using this knowledge to continually work on improving areas of need
- Actively participated in unit-based Quality Assurance Program. Performed all task with patient-centered focus while seeking opportunities for improvement of processes and treatments. Utilized strong assessment skills to determine necessary patient care. Practice as Director of Nursing covering unit of 264 bed skilled/long term care facility
- Established and monitored infection control programs to provide safe, sanitary environment to prevent transmission of disease and infection.
- Developed positive employee relations, incentives and recognition programs to promote teamwork and mutual respect.
- Developed and updated policies and procedures, maintaining compliance with statutory, regulatory and local, state and federal guidelines relating to HIPAA, benefits administration and general liability.
- Direct day-to-day administrative and operational functions for 264 bed facility, providing guidance and leadership to over 175 employees across more than 3 departments.
Education
Bachelor of Science -
University of Cincinnati
Cincinnati, OH06.2010
Associate of Science - Nursing
The Christ Hospital School of Nursing
Cincinnati, OH05.1998
Skills
- Experience with creating & completing Quality Audits (ex-production, safety, infection control, risk assessment audits)
- Experience with effectively managing/leading team of 12 RN's, 22 STNAs, 2 Chaplains, 2 Social Workers remotely while driving metrics and improving team's performance
- Completing root cause analysis (ex-events & casual factor analysis, change analysis, barrier analysis, management oversight and risk tree analysis)
- Proven ability to function as leader of multi-disciplinarian team to achieve desired goals and outcomes while maintaining team cohesiveness, stability, and positive team culture/morale
- 15 years progressive leadership experience
- Well-versed NCQA & CMS Standards
- Well versed in utilizing multiple technology & software tools (ex- HCHB, QSHR, Inovalon, Captivity, EPIC, PCC, InterQual & Milliman)
- CHAP/JCAHO survey experience
- Apply knowledge of evidence-based practice and integrating best current evidence with clinical expertise, patient/family preferences and values
- Oversee day to day clinical operations
- Review all documentation of medical records for completion and accuracy, staff education, training incident/accident investigation and follow up care
- Use data to monitor outcomes of care processes and quality improvement methods
- Current unrestricted compact licensure
- Current unrestricted single state licensure in OH, VT, IL, NY, FL, CA
- Exceptional progressive leadership ability to drive quality and production metrics without sacrificing patient care
Certification
*RN Licensed COMPACT, Independent NY, IL, CA, VT licensure
CHPN 2017 to current
CDE 2016 to current
CCM 2015 to current
FPS 2014 to current
CPI 2012 to current
WCC 2000 to current
ACLS 1998 to current
*COVID Vaccinated w/ booster shot
Timeline
Quality Review & Audit Lead Representative
CIGNA Healthcare
01.2023 - Current
RN Clinical Team Manager
Queen City Hospice
12.2017 - 01.2022
RN Over Reader Nurse/NYIA ASSESSOR **SEASONAL
Total Med/ADDUS
01.2012 - 01.2023
Home Health Nurse/Float Floor Nurse/Utilization Review Nurse
Brown County Regional Hospital
05.2007 - 12.2017
DIRECTOR OF NURSING, MDS COORDINATOR
Batavia Nursing Care Center
12.1998 - 05.2007
Bachelor of Science -
University of Cincinnati
Associate of Science - Nursing
The Christ Hospital School of Nursing
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