Melissa Johnson
Nicholson,GA
Summary
Seasoned 34 year nursing professional working with critically ill infants and children in level 3 NICU. Proven clinical knowledge, natural interpersonal strengths and technical abilities. 14 yrs Clinical Review experience and expert knowledge in hospital setting and Care Mgmt organization to include onsite, telephonic, and remote. Expert in EPIC charting, Computer systems, Levels of care and ICD-10 codes. Quality-focused and efficiency-driven leader. Extensive performance with adult/pediatric clinical reviews in meeting admission standards per Interqual criteria. Expert specialty with NICU patients providing bedside care, leadership and education. Seeking career development and advancement to include multi-disciplines.
Overview
34
34
years of professional experience
1
1
Certification
Work History
NICU/Pediatric Concurrent Review Nurse
Centene Management Company LLC
02.2016 - Current
- Improved patient outcomes by conducting thorough concurrent reviews to include referring denied cases appropriately.
- Attention given to productivity/QA
- Initiates physician communications relative to UR process and followups (peer to peer, denials)
- Working knowledge of financial aspects of 3rd party payor and reimbursements.
- Effective decision making/problem solving to complete timely reviews using relevant information per utilization review process
- Above average computer skills with multiple applications.
- Reduced hospital readmission rates with timely assessments and effective discharge planning.
- Enhanced interdisciplinary collaboration by participating in daily rounds, discussing patient cases, and providing clinical input.
- Streamlined utilization review process for more efficient case management and improved resource allocation.
- Increased compliance with regulatory standards through meticulous documentation of clinical decisions and interventions.
- Supported effective care transitions by collaborating with healthcare providers, patients, and families to develop individualized discharge plans.
- Conducted comprehensive chart reviews to assess medical necessity, ensuring optimal reimbursement levels for services rendered.
- Identified opportunities for improvement within case management department, contributing to overall operational efficiency gains.
- Promoted culture of continuous learning by staying current on industry best practices and sharing knowledge with colleagues.
- Maintained accurate records of case management activities in accordance with organizational policies and procedures, ensuring data integrity for reporting purposes.
Utilization Review RN
Children's Healthcare Of Atlanta
04.2010 - 02.2016
- Effective decision making/multi tasking to complete timely clinical reviews using relevant clinical information per UR process.
- Evaluates patients for admit type, setting, level of care per clinical information and appropriately reviews criteria within 24 hr time frame.
- Working knowledge of financial aspects of 3rd party payor and reimbursements.
- Complete precert process using clinical information.
- Effective communication with medical directors relative to UR process and denials (peer to peer) and followup.
- Proficient in EPIC, Interqual, Windows computer systems.
- Team player and participate in staff meetings.
Clinical Nurse
Gwinnett Medical Center-Lawrenceville
04.1995 - 02.2016
- Functioned as charge nurse, new employee preceptor and mentor to coworkers with hands on bedside care to critically ill NICU level 3 babies
- NRP resuscitation team and class instructor
- CPR instructor
- Discharge coordinator
- Transport team coordinator and Transport team member
- Enhanced patient care by implementing evidence-based nursing practices and protocols.
- Reduced hospital readmissions by providing thorough discharge education and follow-up support to patients.
- Collaborated with interdisciplinary teams for optimal patient outcomes and efficient care coordination.
- Streamlined workflow processes, improving overall efficiency within unit.
Registered Nurse, NICU
Northside Hospital Atlanta
05.1990 - 06.1997
- Neonatal resuscitation team member, charge nurse and educator
- Enhanced patient care by implementing evidence-based nursing practices and protocols in NICU setting.
- Reduced complications by closely monitoring vital signs, administering medications, and assessing newborns'' overall condition.
- Collaborated with multidisciplinary healthcare teams to develop individualized plans of care for premature and critically ill neonates.
- Promoted family-centered care by providing education, support, and resources to parents of NICU patients.
Education
Bachelor of Science - Prenursing Studies
University of Georgia
Athens, GABachelor of Science - Nursing
Emory Univ/Nell Hodgson Woodruff School of Nursing
Atlanta, GA05.1990
Skills
Utilization Review
Care coordination
Multi tasking
Decision Making
Attention to Detail/Performance
Strong computer knowledge
Strong typing ability 60 wpm
Clinical judgement
Interqual/ EPIC super user/ ICD-10
EMR systems
Denials/Appeals
Educator/Transport RN coord//NRP instructor/CRP instructor
Discharge Planner/Supervisor/Charge positions
Staff Preceptor
Certification
NCC Neonatal Intensive Care Nursing RNC-NIC (exp 12/15/2025)
Timeline
NICU/Pediatric Concurrent Review Nurse
Centene Management Company LLC
02.2016 - Current
Utilization Review RN
Children's Healthcare Of Atlanta
04.2010 - 02.2016
Clinical Nurse
Gwinnett Medical Center-Lawrenceville
04.1995 - 02.2016
Registered Nurse, NICU
Northside Hospital Atlanta
05.1990 - 06.1997
Bachelor of Science - Prenursing Studies
University of Georgia
Bachelor of Science - Nursing
Emory Univ/Nell Hodgson Woodruff School of Nursing
NCC Neonatal Intensive Care Nursing RNC-NIC (exp 12/15/2025)
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