Janice Pullins-Brown

Utilization Review Specialist, InterQual Certified Instructor (IQCI) | June 2019 – Present

Hines VA Hospital is a 1A complexity facility operating 483 beds and six community-based outpatient clinics (Elgin, Kankakee, Oak Lawn, Aurora, LaSalle, and Joliet).

• Perform daily utilization management reviews in collaboration with physicians and multidisciplinary teams to ensure appropriate levels of care and accurate documentation.

• Partner with clinical leadership to redesign workflows for medical and surgical admissions, optimizing patient throughput and reducing hospital length of stay.

• Conduct daily admission status reviews for commercial and government payers to ensure proper patient placement.

• Collaborated with Patient Access Services and Inpatient Management leadership to implement a standardized admission, transfer, and discharge workflow—improving data accuracy and reducing readmission rates.

• Provide education to Administrative Officers on Duty and Medical Assistants regarding eligibility verification, insurance review, and off-tour admission placement, improving service access and reimbursement outcomes.

• Serve as VISN 12 InterQual Certified Instructor, conducting mandatory annual training and quarterly audits to ensure compliance with VHA directives and Optum medical review standards.

• Mentor and precept UM team members, advancing clinical competence and consistency in review practices.

• Advise the Chief of Quality, Chief of Staff, and Medical Center Director on utilization trends, hospital flow, and performance improvement initiatives.

• Managed 30–35 inpatient cases daily, including concurrent, surgical, and outpatient utilization reviews.

• Produced monthly UM performance reports to assess VHA directive compliance and identify workflow inefficiencies

. • Led initiatives to enhance shared decision-making processes and improve emergency department utilization, patient experience ratings, and discharge planning effectiveness.

• Provided education and mentorship to colleagues to elevate professional practice and patient outcomes.

Facilitates Multidisciplinary rounds and supported social workers, nursing staff MD's in development of individualized , evidenced based, outcomes and safe practice

Ensured payer compliance through admission and continued stay reviews, reducing denials and improving financial outcomes.

Collaborated with physicians, care teams, and payers to coordinate efficient, patient-centered transitions of care.

Served as a clinical expert for Certification Level of Care determinations, enhancing case review accuracy and reimbursement integrity.

Used approved criteria for admissions and continued stay reviews to ensure appropriate setting ad timely implementation of plan of care.

Participated in the recruitment of new physicians to support the internal Physicians Utilization Management Advisor team, this recruitment and physician engagement has increased the awareness of job responsibilities of the UM department and the potential financial outcome to the facility due to lack of collaborative work between the teams

Manage designated caseloads of medical and disability workers compensation claims

Communicate with injured workers medical professionals claim staff and others to obtain information necessary to make sound medical assessments regarding medical-physical diagnosis and prognosis

Assumed Charge Nurse role and cared for diversified population

Assisted with managing staff schedule

Employed critical thinking skills, assessed patients condition to ensure pt received optimal care.

Provided care for patients suffering from life threatening illnesses, with proven expertise in Acute patient care, staff development and family advocacy

Recognized as an excellent care provider and patient advocate.

Educate patient and family on disease management

Proficiencies include:

Ventilator Care, Telemetry, 12Lead EKG, Intravenous Therapy, ICU, CCU CVP, Arterial and Central lines IABP, CABG . AV fistulas, operate equipment PCA pump