Juliet Nnaji
San Antonio,TX
Summary
Registered nurse with 12 years of working experience in acute and managed care settings. A dedicated health care professional with sound clinical knowledge and critical thinking skills committed to providing high-quality patient care and efficient utilization of health care resources. Some management experience leading teams, teaching new concepts and developing best practice strategies.
Overview
1
1
Certification
12
12
years of professional experience
Work History
Manager, Clinical Staff Education
Community First Health Plans
10.2025 - Current
- Developed and implemented educational programs to enhance staff competencies.
- Developed job aids and internal policies for staff
- Facilitated training sessions using adult learning principles to improve knowledge retention.
- Collaborated with multidisciplinary teams to design curriculum aligned with organizational goals.
- Mentored preceptors on instructional techniques and best practices for engaging new employees.
- Evaluated training effectiveness through feedback and performance assessments, ensuring continuous improvement.
- Spearheaded initiatives to standardize onboarding processes for new hires.
- Participated in professional development opportunities, staying up-to-date on current teaching methodologies and consistently improving instructional techniques.
- Collaborated with colleagues to develop and revise curriculum, enhancing learning experience.
Manager, Utilization Review
Community First Health Plans
09.2023 - 10.2025
- Authored and assisted in updating organizational desk procedures and medical policies.
- Received training on preparing department reports and completing such reports within established timeframes.
- Prepared meeting agenda and powerpoint slides for periodic department meetings.
- Managed job assignments and ensured that staff complete their assigned tasks.
- Conducted annual staff evaluations and conveyed constructive feedback to improve skills.
- Conducted staff trainings on new and existing processes.
- Established performance goals for employees and provided feedback on methods for reaching those milestones.
Supervisor - Nurse Case Manager & Utilization Management
Community First Health Plans
01.2022 - 09.2023
- Supervised a team of nurses in utilization review, authorization and case management duties.
- Conferred with UM Medical Directors regarding inpatient/outpatient cases.
- Participated in the development and training efficient workflow processes to improve quality of care.
- Provided guidance, and support to nurses in the team and trained new staff.
- Utilized audit tools to perform documentation audits on job functions within the Utilization Management department.
- Assisted with updating desk procedures related to the utilization management and intake duties.
- Ensured compliance with accreditation bodies such as NCQA and relevant health plan requirements.
- Monitored staffing levels and schedules to meet personnel needs.
- Performed monthly audits and annual staff evaluation.
- Coordinated member discharge planning and post-discharge follow-up.
Nurse Case Manager / Utilization Review RN
Community First Health Plans
10.2020 - 01.2022
- Assessed needs related to diagnosis, care, and discharge plans to establish preliminary expectations of care delivery.
- Performed assessment based on clinical indicators and anticipated services for the appropriate level of hospital care by considering safety, quality, and cost.
- Performed a review for clinical authorizations for inpatient/outpatient care utilizing evidenced-based criteria within our documentation system.
- Coordinated service of highly complex cases by collaborating with case managers, behavioral health systems, early intervention, and Medicaid.
- Maintained accurate and detailed records of patient treatments and status updates and review notes in the clinical systems.
- Referred cases to UM Medical Director as appropriate for review for cases not meeting medical necessity criteria or for complex case situations.
- Supplied information relating to the plan of care, regulatory requirements, and benefits management by communicating and collaborating with providers.
- Contacted physician and other health care professionals when admission did not meet acute care guidelines.
Registered Nurse
Methodist Healthcare
02.2018 - 05.2019
- Delivered high-quality nursing care by assessing, implementing, and evaluating care provided to patients in the assigned unit.
- Consulted and coordinated with healthcare team members to assess, plan, implement, and evaluate patient care plans.
- Administered prescribed medications and monitored patients for side effects and adverse reactions.
- Completed detailed patient intakes, including documenting patient histories and current vitals.
- Monitored patients closely to spot problems and reported serious concerns to treating physicians for timely interventions.
- Prepared patients for physician examinations and treatments, answered questions, and offered emotional support.
- Maintained accurate, detailed reports and records.
- Followed all guidelines and policies set by assigned units and facilities.
RN - Med/Surg
Comanche County Memorial Hospital
07.2014 - 07.2017
- Delivered direct patient care according to established standards.
- Collect, record, and maintain patient information, such as medical history, reports, and examination results.
- Monitor patients' conditions and responses, and change care plans accordingly. Administer blood and blood product transfusions or intravenous infusions, monitoring patients for adverse reactions.
- Set up, operate, or monitor invasive equipment and devices such as colostomy or tracheotomy equipment, mechanical ventilators, catheters, gastrointestinal tubes, and central lines.
- Collaborate with members of multidisciplinary health care teams to coordinate care for effective and current care plans.
- Provided pre-and post-op teaching and nursing care.
- Provide formal and informal education to other staff members.
- Monitored patients closely to spot problems and reported serious concerns to treating physicians for timely interventions.
Education
Master's Degree in Nursing - Nurse Executive Specialty
Walden University
Minneapolis, Minnesota12-2026
Bachelor of Science - Nursing
Northwestern Oklahoma State University
Alva, Oklahoma06-2018
Associate of Science - Nursing
Western Oklahoma State College
Altus, Oklahoma05-2014
Bachelor of Science - Microbiology
University of Calabar
Nigeria12-2010
Skills
- Knowledge and Experience with InterQual, NCQA, Medicaid and Medicare
- Knowledge of Medical Management Systems
- Utilization Review
- Teamwork
- Critical Thinking
- Effective Communication
- Attention To Detail
- Staff education and training
- Healthcare regulations
- Care management
- Clinical assessment
Certification
- Certified Case Manager, The Commission for Case Manager Certification (CCM)
- Lean Six Sigma White Belt Certification (LSSWB)
- InterQual Certified Instructor (IQCI)
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Manager, Clinical Staff Education
Community First Health Plans
10.2025 - Current
Manager, Utilization Review
Community First Health Plans
09.2023 - 10.2025
Supervisor - Nurse Case Manager & Utilization Management
Community First Health Plans
01.2022 - 09.2023
Nurse Case Manager / Utilization Review RN
Community First Health Plans
10.2020 - 01.2022
Registered Nurse
Methodist Healthcare
02.2018 - 05.2019
RN - Med/Surg
Comanche County Memorial Hospital
07.2014 - 07.2017
Bachelor of Science - Microbiology
University of Calabar
Associate of Science - Nursing
Western Oklahoma State College
Bachelor of Science - Nursing
Northwestern Oklahoma State University
Master's Degree in Nursing - Nurse Executive Specialty
Walden University