LaMonica Johnson
Registered Nurse And Manager
Monroe,LA
Summary
Registered Nurse with over 20 years of successful experience in clinical healthcare and managed care. Recognized consistently for performance excellence and contributions to success in the healthcare industry. Strengths in clinical, case management, and quality backed by educational training in nursing and healthcare administration.
Overview
7
7
years of professional experience
10
10
years of post-secondary education
2
2
Certifications
Work History
Manager of Medical and Clinical Operations
UnitedHealthcare Community Plan
Baton Rouge, LA
11.2019 - Current
- Leads projects and analyzed data to identify opportunities for improvement
- Creates plans and communicated deadlines to ensure projects were completed on time
- Participates in continuous improvement by generating suggestions, engaging in problem-solving activities to support teamwork
- Collaborates with Louisiana Department of Health's Hepatitis C improvement program
- Develops policies, procedures, and guidelines for medical and clinical operation programs
- Identifies and implements business development opportunities to support growth of operations
- Navigates technology and software applications utilized in delivery of programs
- Implements business continuity plans to minimize interruptions in business
- Evaluates compliance with federal, state and local regulatory guidelines
- Evaluates programs against accreditation standards and contractual guidelines
- Reviews financial reports to identify financial performance gaps
- Conducts cost/benefit analysis on programs to drive efficiencies
- Works closely with leadership to maintain optimum levels of communication to effectively and efficiently complete projects
- Manages team of 13 case managers who provide services to health plan members from diverse backgrounds
- Develops team communications and information for meetings.
- Resolves conflicts and negotiated mutually beneficial agreements between parties
- Prepares reports for Louisiana's managed care reporting deliverables
- Conducts staff audits and implements performance reviews and improvement plans
Project Quality Manager
Aetna, A CVS Health
Baton Rouge, LA
05.2019 - 11.2019
- Updated quality control standards, methods and procedures to meet compliance requirements.
- Implemented new rework procedures to standardize processes and streamline workflow.
- Identified gaps in care and provided recommendations related to workflows and processes
- Creation and initiation of maternal health programs for high-risk members
- Identification and collaboration with external vendors for new and existing program
- Performed audits of case management records and documentation
- Collaborated with departments in population health management strategies and framework
- Managed state's maternal health performance improvement project to decrease member preterm births and increasing 17-P utilization by 5%.
- Interdepartmental collaborations in quality improvement initiatives
Manager of Healthcare Management Services
Anthem
Baton Rouge, Louisiana
01.2015 - 05.2018
- Developed and created programs and monitored effectiveness against individual participant needs.
- Supported quality initiatives and activities including adherence to National Committee for Quality Assurance (NCQA) standards and HEDIS reporting
- Supervision and management of team of over 40 behavioral health and physical health case managers responsible for case finding and coordinating cases that involve co-morbid conditions
- Worked with senior case managers to coordinate team development activities and trainings.
- Partnered with providers to establish short and long term goals that meet members' needs, functional abilities, and referral sources requirements
- Oversaw staff development through in-depth trainings, workshops, seminars and other learning opportunities.
- Coordinated individual referrals to obtain community services, advocated for client needs and resolved roadblocks.
- Collaborated with disease management, utilization management, quality, and appeals departments in member outreach and outcomes
- Recruited, interviewed, and hired staff members offering exceptional talent and brought great skills to team.
- Implemented programs and initiatives to identify care gaps to improve health outcomes and meet organizational goals
- Established and maintained relationships with leadership within organization to implement business strategies and initiatives
- Initiated projects to outreach sickle cell and non virally suppressed HIV members as well as members with high emergency room utilization
- Drove operational improvements which resulted in savings and improved profit margins.
- Supported program compliance, promoted health service strategies, developed programs for clinical operations, and assisted in identifying opportunities to improve customer service, quality outcomes, and patient experiences
Patient Center Medical Home Specialist
Centene
Baton Rouge, Louisiana
01.2014 - 01.2015
- Participated in continuous improvement by generating suggestions, engaging in problem-solving activities to support teamwork
- Collection of required documentation for NCQA's PCMH recognition
- Utilized evidence based, data driven approach to facilitate multi-disciplinary quality improvement team working directly within practices
- Developed appropriate action plans to close provider care gaps
- Worked with practices who have achieved PCMH recognition to meet annual audits required to maintain recognition per NCQA
- Education and training of clinicians and staff at practices with regard to external regulatory standards and performance improvement activities
- Conducted audit reports for meeting quality and financial objectives
Education
Doctor of Nursing Practice - Nursing
University of New Hampshire
Durham, NH 01.2019 - 05.2021
Master of Health Administration - Health Administration
Louisiana State University At Shreveport
Shreveport, LA 01.2016 - 12.2017
Bachelor of Science - Nursing
Grambling State University
Grambling, LA 08.1992 - 05.1998
Skills
Analytical skills
Certification
Certified Six Sigma Green Belt
License
Louisiana State Board of Nursing
Registered Nurse
Expiration January 2023
Timeline
Certified Six Sigma Green Belt
09-2020
Manager of Medical and Clinical Operations
UnitedHealthcare Community Plan
11.2019 - Current
Statistical Analysis Software (SAS)
07-2019
Project Quality Manager
Aetna, A CVS Health
05.2019 - 11.2019
Doctor of Nursing Practice - Nursing
University of New Hampshire
01.2019 - 05.2021
Master of Health Administration - Health Administration
Louisiana State University At Shreveport
01.2016 - 12.2017
Manager of Healthcare Management Services
Anthem
01.2015 - 05.2018
Patient Center Medical Home Specialist
Centene
01.2014 - 01.2015
Bachelor of Science - Nursing
Grambling State University
08.1992 - 05.1998
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