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Joanna Swindle

@joannaswindle

Experienced Utilization Management RN specializing in post-acute care transitions.

United States
Message

What I'm looking for

I’m seeking a utilization management or case management role where I can lead clinical reviews, improve care transitions, and collaborate with providers to ensure patient-centered, timely post-acute care.

I am a driven Utilization Management Nurse with a BSN and active compact RN licensure, focused on ensuring appropriate, timely care transitions from acute to post-acute settings. I pioneered and helped develop the UM Post-Acute Pre-Authorization (PAPA) pilot, conduct clinical reviews using CMS and InterQual guidelines, and serve as a weekend medical on-call nurse managing Medicare appeals.

My strengths include strong clinical judgment, attention to detail, high autonomy, and professional communication that builds collaborative relationships with SNFs, providers, PCPs, case management directors, members and families. I consistently advocate for patient-centered discharge planning and resource coordination to optimize continuity of care and outcomes.

Experience

Work history, roles, and key accomplishments

Humana logoHU
Current

Utilization Manager RN

Jan 2018 - Present (7 years 8 months)

Led Utilization Management for post-acute pre-authorization (PAPA) operations, piloted the PAPA program and developed role guidelines, and conducted timely clinical reviews for SNF admissions while supporting weekend on-call medical decisions and Medicare appeals.

Education

Degrees, certifications, and relevant coursework

Auburn University logoAU

Auburn University

Bachelor of Science, Nursing

2000 - 2000

Grade: Cum Laude

Completed a Bachelor of Science in Nursing, graduating Cum Laude in June 2000.

CS

Coffee Springs High School

High School Diploma, High School Diploma

1991 - 1991

Grade: Top 5% of class

Graduated with a High School Diploma in May 1991 and ranked in the top 5% of the class.

Tech stack

Software and tools used professionally

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Joanna Swindle - Utilization Manager RN - Humana | Himalayas