Dametrice Johnson, RN
Johns Creek,GA
Summary
Compact licensed RN in the state of Georgia, specializing in Utilization Review and Prior Authorization with 3+ years in high-volume settings. Skilled in assessing diverse healthcare services and proficient in InterQual and Milliman criteria. Expert in EMRs like EPIC and Cerner. Committed to quality care and regulatory compliance for enhanced patient outcomes.
Overview
11
11
years of professional experience
Work History
Utilization Review Nurse
Northside Hospital
01.2021 - Current
- Completed Utilization and determined medical necessity
- Performed reviews for Home Health, Skilled Nursing, and DME Services
- Performed 15-20 case reviews per day
- Performed Utilization and Criteria reviews using InterQual and Milliman Care Guidelines.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services
- Assisted with admissions, appointments, transfers, and discharges
- Reduced hospital readmissions by providing thorough discharge planning and follow-up care coordination.
CLINICAL REVIEWER (Contract)
CareCentrix
02.2022 - 08.2022
- Perform prior authorization for post-acute care services for WellCare and Horizon plans
- Perform reviews for inpatient rehabilitation, long term acute care, and skilled nursing services
- Perform high volume authorizations with 4 hour TAT times
- Review clinical information and utilize clinical criteria including MCG and InterQual to determine medical necessity and eligibility
- Perform utilization management with a caseload of 10-12 per day
- Evaluate medical guidelines and benefit coverage to determine appropriateness of services
- Interact with the Medical Director as needed, to ensure proper medical necessity decisions
EMERGENCY DEPARTMENT TECHNICIAN
Northside Hospital
12.2015 - 01.2021
- Assisted with resuscitation, CPR and emergency airway procedures
- Performed EKGs, phlebotomy lab draws, urinary catheters and orthopedic splints
- Liaised between nurses, physicians, patients, and visitors
- Measured vital statistics, collected specimens for lab analysis and recorded data in medical record
- Assessed the extent and nature of injuries or illness, to prioritize and establish medical procedures.
Chemical Dependency Professional
Sunrise Detox Center
01.2014 - 01.2016
- Provided care to patients seeking medical detox from a chemical dependency in an acute setting
- Conducted admission interviews and subsequent documentation, which includes psychiatric and medical health history
- Proficient use in diagnostic codes ICD-10 and DSM 5 for electronic medical records and health insurance
- Assisted and counseled over 20 patients daily.
MEDICATION TECHNICIAN
Arbor Terrace Assisted Living
08.2013 - 01.2015
- Administered prescribed medications and monitored patient progress to document effects
- Performed and monitored patient vital signs as well as report any change in health status to medical staff
- Offered immediate assistance in emergency and routine paging situations to evaluate needs and deliver care
Education
Associate of Science - Registered Nursing
Chattahoochee Technical College
Marietta, GA12.2023
Skills
- Utilization Management
- Clinical Knowledge
- InterQual and Milliman Care Guidelines
- Tech Proficient
- Medical Necessity Evaluation
- Written and Verbal Communication skills
- Care Coordination
- Skilled Nursing
Timeline
CLINICAL REVIEWER (Contract)
CareCentrix
02.2022 - 08.2022
Utilization Review Nurse
Northside Hospital
01.2021 - Current
EMERGENCY DEPARTMENT TECHNICIAN
Northside Hospital
12.2015 - 01.2021
Chemical Dependency Professional
Sunrise Detox Center
01.2014 - 01.2016
MEDICATION TECHNICIAN
Arbor Terrace Assisted Living
08.2013 - 01.2015
Associate of Science - Registered Nursing
Chattahoochee Technical College