KADI JOHNSON, RN, CCM
Advanced Home Health
Pocatello,ID
1
Certification
13
years of professional experience
Registered Nurse and Certified Case Manager (CCM) with 10+ years of progressive clinical experience across complex case management, population health, home health, hospice, surgical/PACU, and acute care. Experienced in providing individualized clinical education, patient engagement, health coaching, care coordination, and ongoing support for patients with complex medical and psychosocial needs. Skilled in identifying barriers to treatment adherence and self-management, adapting education to individual needs and health literacy, and partnering with patients, caregivers, healthcare providers, and interdisciplinary teams to improve outcomes. Strong clinical judgment, relationship-building, documentation, and remote communication skills with a patient-centered approach to delivering safe, compliant, meaningful support.
Work History
Nurse Case Manager Clinician
4 Years- Provide individualized clinical support and complex case management for members with diverse medical, behavioral, social, and healthcare-system needs.
- Perform comprehensive and ongoing assessments to identify clinical needs, treatment barriers, risks, patient goals, and opportunities for intervention.
- Identify barriers affecting treatment adherence, self-management, engagement, and access to appropriate care, including social determinants of health.
- Use motivational interviewing, health coaching, active listening, and relationship-based engagement to build confidence and support sustainable behavior change.
- Adapt communication and education to individual member needs, preferences, readiness for change, understanding, and health literacy.
- Serve as a consistent clinical point of contact, providing continuity and reducing fragmentation across healthcare services.
- Develop and prioritize individualized interventions based on clinical assessment, member goals, needs, preferences, and identified barriers.
- Coordinate with physicians, healthcare providers, families, caregivers, and interdisciplinary teams to address patient needs and support positive outcomes.
- Lead complex transitions of care and facilitate communication across healthcare settings to promote safe and effective continuity of care.
- Provide education regarding health conditions, care plans, healthcare services, self-management, and available resources.
- Document assessments, interventions, education, coordination activities, outcomes, and follow-up needs accurately within electronic systems.
- Establish and evaluate measurable outcomes aligned with individualized goals and adjust interventions based on member response and changing needs.
- Contributed to a published member success story highlighting the impact of individualized complex care management.
RN Case Manager
4 Years 6 Months- Independently manage complex patient needs through comprehensive assessment, individualized care planning, intervention, coordination, monitoring, and evaluation.
- Complete initial and ongoing patient and caregiver assessments and tailor education and care plans to individual clinical and psychosocial needs.
- Provide disease-management education, medication-related education, self-management support, and ongoing clinical monitoring.
- Identify barriers affecting treatment, recovery, adherence, and access to services and develop appropriate interventions.
- Communicate directly with physicians and interdisciplinary professionals regarding changes in condition, medications, treatment needs, and patient goals.
- Maintain accurate clinical documentation while following Medicare, OASIS, home-health regulatory, and clinical documentation requirements.
Registered Nurse, Same Day Surgery/PACU
1 Year 9 Months- Performed comprehensive preoperative and postoperative assessments and monitored patients throughout the surgical and recovery process.
- Provided patient education and reinforced instructions to promote understanding, safety, and successful recovery.
- Recognized changes in patient condition and promptly communicated clinical concerns to physicians and other members of the care team.
- Collaborated with surgeons, anesthesiologists, nurses, and other healthcare professionals to coordinate safe, patient-centered care.
RN Case Manager
1 Year 5 Months- Managed patients throughout the hospice continuum using comprehensive clinical, psychosocial, and family assessment.
- Developed individualized plans of care based on patient goals, clinical needs, caregiver needs, and changing conditions.
- Provided ongoing clinical assessment, patient and caregiver education, symptom-management support, and care coordination.
- Communicated closely with physicians, patients, families, caregivers, and interdisciplinary team members.
- Independently managed a caseload of 20–27 patients while maintaining timely documentation and follow-up.
RN Case Manager
2 Years 8 Months- Independently managed a caseload of 27–34 patients while coordinating comprehensive home-health services.
- Completed clinical assessments and developed individualized care plans based on patient needs, goals, and clinical findings.
- Provided patient and caregiver education and ongoing clinical monitoring.
- Identified barriers affecting treatment and access to care and advocated for appropriate services.
- Coordinated with physicians and interdisciplinary professionals to communicate patient needs and support positive outcomes.
- Reviewed insurance denials and submitted appropriate documentation for prior authorization.
Licensed Practical Nurse / Float Nurse
2 Years 10 Months- Provided direct patient care across multiple specialty clinics and clinical departments.
- Performed assessments, treatments, medication administration, clinical procedures, patient education, and documentation.
- Collaborated with physicians, nurses, and multidisciplinary teams to support comprehensive patient care.
- Provided patient education and assisted with care coordination and follow-up.
- Clinical exposure included Behavioral Health, Cancer Center, Cardiology, Urology, Wound Care, Surgical Specialties, Neuroscience, Pain Management, Brain and Spine Neurosurgery, Lung and Sleep Center, and Infectious Disease.
Education
Registered Nurse
Licensed Practical Nurse
Skills
Clinical Assessment
Patient Education
Disease-Process Education
Treatment Adherence Support
Patient/Caregiver Engagement
Health Coaching
Motivational Interviewing
Telephonic Case Management
Complex Case Management
Care Coordination
Chronic Disease Management
Barrier Identification
Patient Advocacy
Provider Collaboration
Triage
Clinical Documentation
EMR/EHR Systems
HIPAA-Conscious Practice
Interdisciplinary Collaboration
Transitions of Care
Social Determinants of Health
Certification
Registered Nurse: Active Idaho Compact, California, Oregon, Nevada, and Washington licenses
Certified Case Manager (CCM)
BLS
ACLS
PALS
Timeline
Nurse Case Manager Clinician
Cambia Health Solutions
10.2022 - CurrentRead More
RN Case Manager
Advanced Home Health
04.2022 - CurrentRead More
Registered Nurse, Same Day Surgery/PACU
Portneuf Medical Center
07.2020 - 04.2022Read More
RN Case Manager
Heritage Hospice
02.2019 - 07.2020Read More
RN Case Manager
Encompass Home Health
06.2016 - 02.2019Read More
Licensed Practical Nurse / Float Nurse
Portneuf Medical Center
08.2013 - 06.2016Read More
Idaho State University
Licensed Practical Nurse
Read More
Idaho State University
Registered Nurse
Read More
CORE COMPETENCIES
- Patient Support & Engagement
- Clinical & Disease-State Education
- Treatment Adherence Support
- Patient & Caregiver Education
- Complex Case Management
- Clinical Assessment
- Health Coaching
- Motivational Interviewing
- Barrier Identification & Resolution
- Chronic Disease Management
- Care Coordination
- Patient Advocacy
- Provider Collaboration
- Telephonic Patient Support
- Clinical Documentation
- HIPAA & Regulatory Compliance
- Triage & Escalation
- Interdisciplinary Collaboration
- EMR/EHR Systems
- Social Determinants of Health