Victora Johnson

Developed and updated Utilization Management (UM) policies, including researching and developing position statements for new technologies. Performed claims review, including provider dispute resolution and high-cost claim review, while analyzing trends for pended claims to recommend process improvements.

Delivered nursing interventions consistent with medical plans of care, utilizing the nursing process to assess, implement, and record patient responses. Scheduled appointments, tests, and procedures, provided patient education, and triaged patient phone inquiries.

Administered Pfizer and Moderna vaccinations to adults, adolescents, and children at various locations. Monitored patients for adverse reactions, provided education on reporting symptoms, and collected patient history prior to administration.

Collected medical information and applied evidence-based guidelines to determine medical necessity, including training team members on clinical template modifications. Served as a subject matter expert, evaluating clinical content usage and executing improvements on current clinical libraries and processes.

Analyzed data for integrity and deficits, documenting findings and trending HEDIS/STAR rates to identify improvement barriers. Collaborated with local leadership to execute quality strategies and supported PCPs/clinics with quality data collection.

Collected, analyzed, and evaluated clinical documentation using established criteria to determine the appropriateness of clinical decisions. Ensured adherence to regulatory and departmental timeframes for review requests and supported all utilization management activities.

Conducted telephonic outreach, documented assessments, and developed service plans, ensuring authorizations were completed. Assessed members' medical, safety, and support service needs, coordinating service delivery and providing health education.

Observed and recorded patient behavior, performed physical examinations, and collected patient health history. Counseled and educated patients and their families on treatment plans, administered medication, and changed wound dressings.

Observed and recorded patient behavior, performed physical examinations, and collected patient health history. Counseled and educated patients and their families on treatment plans, administered medication, and changed wound dressings.

Completed a Bachelor of Science in Nursing, gaining comprehensive knowledge and practical skills essential for professional nursing practice. Focused on patient care, health assessment, and clinical procedures.

Earned an Associate of Applied Science in Nursing, building foundational knowledge in nursing principles and patient care. Developed skills in clinical settings and prepared for entry-level nursing roles.

Obtained a License in Vocational Nursing, focusing on practical nursing skills and patient support. Prepared for roles assisting registered nurses and providing direct patient care.