Johnna Rawlings
Summary
Dedicated nursing professional with extensive experience in utilization review, skilled in analyzing patient care and ensuring compliance with healthcare regulations. Proven ability to foster team collaboration while consistently achieving optimal patient outcomes. Recognized for adaptability and reliability, excelling in dynamic environments that require precise decision-making and effective communication skills. Committed to enhancing patient care quality through a comprehensive understanding of clinical processes and regulatory standards.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Utilization Review Nurse
Sentara Heath Plans
11.2021 - Current
- Conducted comprehensive reviews of medical records to determine clinical necessity and appropriateness of care.
- Collaborated with healthcare providers to ensure compliance with utilization management policies and guidelines.
- Utilized electronic health record systems to track and manage patient care authorizations effectively.
- Developed and implemented strategies for improving review processes, enhancing efficiency in case evaluations.
- Reduced healthcare costs through efficient utilization of resources and identification of unnecessary treatments or procedures.
- Utilized coding and clinical expertise to identify opportunities, and ensure the accuracy and completeness of clinical documentation in alignment with ICD-10 standards.
Surgical Coordinator/Prior Authorization Specialist
Bon Secours
05.2019 - 11.2021
- Coordinated patient scheduling to optimize surgical procedures and reduce wait times.
- Managed pre-operative documentation to ensure compliance with regulatory standards.
- Collaborated with surgical teams to streamline communication and enhance workflow efficiency.
- Maintained accurate patient records using electronic health record (EHR) systems.
- Assists other members of the department as needed with injections and procedures.
LPN Field Nurse
American Critical Care Services
01.2018 - 01.2021
- Administered medications and treatments according to established protocols and patient care plans.
- Collaborated with healthcare teams to develop personalized care strategies for patients in home settings.
- Conducted comprehensive patient assessments to monitor health status and report changes to physicians.
- Educated patients and families on managing health conditions and medication adherence effectively.
LPN Charge Nurse
Hiram W. Davis Medical Center
01.2016 - 12.2017
- Provided direct, hands-on care for a high volume of patients, with a specialized focus on those with tracheostomies and complex respiratory needs.
- Documented all patient care, observations, and interventions in the Electronic Medical Record (EMR) system, adhering to all hospital policies.
- Educated patients and their families on trach care, maintenance, and emergency protocols, empowering them to manage care at home, and reducing readmission rates.
- Delegated tasks effectively, optimizing staff productivity and maintaining a well-organized nursing unit.
LPN Charge Nurse
Amelia Nursing & Rehabilitation Center
06.2015 - 01.2016
- Conducted comprehensive assessments and monitored vital signs to evaluate patient conditions.
- Coordinated medication administration, ensuring adherence to safety protocols and guidelines.
- Utilized critical thinking skills to make sound clinical decisions in high-pressure situations, minimizing risks and ensuring patient safety.
LPN Charge Nurse
Heritage Hall Healthcare and Rehabilitation Center
08.2014 - 05.2015
- Assessed patients' temperature, pulse, and blood pressure and recorded in electronic medical records.
- Assembled and used equipment such as catheters, tracheotomy tubes, or oxygen suppliers to effectively manage patient care.
- Implemented evidence-based nursing practices to improve patient health and maintain compliance with regulatory standards.
Education
Bachelor of Science - BSN
Post University
Waterbury, CT08-2026
Associate of Science - Registered Nurse
Galen College of Nursing
Richmond, VA11-2025
Associate of Applied Science -
Richard Bland College
Dinwiddie05-2017
Certificate - Practical Nursing
Petersburg City Schools
Petersburg, VA06-2014
Skills
- MCG Health
- CMS
- ICD-10 coding
- Utilization Review
- Healthcare compliance
- Information collection
- Documentation and reporting
Certification
Registered Nurse, Virginia, 0001342298
Licensed Practical Nurse, Virginia,
0002091041
Timeline
Utilization Review Nurse
Sentara Heath Plans
11.2021 - Current
Surgical Coordinator/Prior Authorization Specialist
Bon Secours
05.2019 - 11.2021
LPN Field Nurse
American Critical Care Services
01.2018 - 01.2021
LPN Charge Nurse
Hiram W. Davis Medical Center
01.2016 - 12.2017
LPN Charge Nurse
Amelia Nursing & Rehabilitation Center
06.2015 - 01.2016
LPN Charge Nurse
Heritage Hall Healthcare and Rehabilitation Center
08.2014 - 05.2015
Bachelor of Science - BSN
Post University
Associate of Science - Registered Nurse
Galen College of Nursing
Associate of Applied Science -
Richard Bland College
Certificate - Practical Nursing
Petersburg City Schools