Evangeline Johnson Email and Phone Number
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Evangeline Johnson is a Senior Clinical Care Reviewer at Select Health of South Carolina at Select Health of South Carolina. She possess expertise in healthcare, utilization management, medicare, healthcare management, managed care and 17 more skills.
Select Health Of South Carolina
View- Website:
- selecthealthofsc.com
- Employees:
- 185
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Senior Clinical Care ReviewerSelect Health Of South Carolina Jan 2012 - PresentAct as subject matter resource for complex authorization requests within the UM precert department for Select Health and Amerihealth Caritas Louisiana. Act as a resource to ICM for questions related to preauthorization of services to facilitate improved case management. Assist UM Supervisor as needed.
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Senior Clinical Care ReviewerSelect Health Of South Carolina Jan 2012 - Jun 2012Act as subject matter expert/resource for complex authorization requests within the UM precert department for Select Health and LaCare. Act as resource to ICM for questions related to preauthorization of services to facilitate improved case management. Assist UM Supervisor as needed.
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Clinical Care Nurse (Utilization Management)Select Health Of South Carolina Dec 2008 - Jan 2012Assess requests for authorization of pre- service inpatient reviews, outpatient services and ongoing home care services. Apply benefit policy and medical management guidelines to authorize services. Identify and refer requests to the Medical Director when guidelines are not met. Review to ensure quality services are being rendered. Help to decrease over/under utilization and reduce medical costs. Assist with training new staff to UM Precert department.
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Utilization Management SupervisorAmerihealth Caritas Jun 2012 - Jun 2013Responsible for providing daily oversight of UM Nurses, the Medical Appeal Coordinator(s) and Triage staff members within Utilization Management. Responsibility includes providing clinical, technical and operational support and direction, including organization and monitoring of all medical services. Responsible for direct supervisory oversight of professional and front line staff receiving requests for authorizations and appeals from external customers which encompasses providers and members, as well as from the internal customers for a new line of business within Amerihealth Caritas Family of Companies. -
Medicare Clinical Documentation SpecialistHill-Rom 2004 - 2008Clinical Review of all documentation submitted for patients nationwide for qualification for placement on Group 3 Support Surface according to Medicare guidelines. Participated in launch activities for Sales Account Managers with extensive distance education support as needed. Communication with sales team, home health agencies and medical professionals regarding patient progress, ongoing medical necessity, clinical documentation, and customer education regarding regulations and guidelines. Initial Pilot completed with processes mainstreamed across the nation. -
Adult Primary Care Case ManagerMedical University Of South Carolina 2001 - 2004Coordinated care for large University outpatient clinic for approximately 12 resident and two attending physicians as well as medical and nursing students as needed. Triaged patient needs and facilitated MD treatments. Administered medications, immunizations, and other treatments ordered by MD. Documented all care provided via electronic medical record. Triaged patients via telephone with appropriate follow up with MD or Pharmacist and patient follow up in a timely manner. Provided in University-wide program seeking national Magnet Status accreditation. Managed onsite clinic drug room including inventory, ordering, safety/infection control and JCAH Standards. -
Account Liaison To Cigna Health Care Of ScGentiva Health Services Apr 2002 - Dec 2002Daniel Island, ScLiaison to Cigna HMO contracted with Gentiva to coordinate home equipment, home infusion, and home health needs to HMO members in South Carolina as well as non contracted PPO members. Main intermediary between Plan and CareCentrix. Participated in weekly CM and hospital discharge planning teleconferences to assist with care planning needs. Presented quarterly metrics to Plan regarding contract activity. Assisted CareCentrix with payment issues on site with Cigna reimbursement department as needed. Visited and provided education to Gentiva Network providers throughout South Carolina -
Multiple Roles Within The AgencyInterim Healthcare Feb 1993 - Apr 2002Charleston, South Carolina AreaHospital Based Home Care Coordinator contracted to the Medical University of SC 2001-2002Operations Manager/Managed Care Liaison 1999-2001Home Care Clinical Supervisor 1999Clinical Review Nurse and Staff Educator 1993-2002
Evangeline Johnson Skills
Evangeline Johnson Education Details
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University Of North FloridaSumma Cum Laude
Frequently Asked Questions about Evangeline Johnson
What company does Evangeline Johnson work for?
Evangeline Johnson works for Select Health Of South Carolina
What is Evangeline Johnson's role at the current company?
Evangeline Johnson's current role is Senior Clinical Care Reviewer at Select Health of South Carolina.
What is Evangeline Johnson's email address?
Evangeline Johnson's email address is ej****@****fsc.com
What schools did Evangeline Johnson attend?
Evangeline Johnson attended University Of North Florida.
What are some of Evangeline Johnson's interests?
Evangeline Johnson has interest in Children, Education, Disaster And Humanitarian Relief, Arts And Culture, Health.
What skills is Evangeline Johnson known for?
Evangeline Johnson has skills like Healthcare, Utilization Management, Medicare, Healthcare Management, Managed Care, Primary Care, Hospitals, Medicaid, Nursing, Hipaa, Customer Service, Healthcare Information Technology.
Who are Evangeline Johnson's colleagues?
Evangeline Johnson's colleagues are Marilyn Brooks, Von Lewis, Elijah Delee, Sandra Fort, Tanisha Daniels, Benita Tipton, Damian Figuereo.
Not the Evangeline Johnson you were looking for?
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Evangeline (Eva) Johnson
Virginia Beach, Va -
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Evangeline Johnson
Licensed Realtor/Broker/Owner At American Dream Realty Of Lexington, LlcGreater Lexington Area -
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