Megan Johanning BSN, RN

• · Review electronic health records for accurate and complete documentation of relevant diagnoses and procedures.
• · Work with physicians to clarify diagnoses and assist/educate with documentation questions as needed.
• · Stay up to date with industry standards by participating in internal and external continuing education related to ACDIS, ICD-10-CM coding, ICD-10-PCS coding, AHA Coding Clinics, and CMS Official Coding Guidelines.

• · Supervise the daily operations and production of the UM staff and ensure appropriate usage of resources to facilitate the UM process.
• · Oversee activities of subordinates by assigning workload, reviewing retrospectively utilization review records prepared for admissions and continued stay reviews, reviewing cases referred to the physician advisor, and providing technical guidance on unusual cases.
• · Determine need for and conducts in-service training to improve quality of admission and continued stay reviews, and to disseminate information concerning new or revised procedures.
• · Works closely with other leaders within the Revenue Cycle to impact overall performance improvement.

• · Review/ direct the review of clinical denials and determine appropriateness of appeal.
• · Collaborate with Medical Advisor for Utilization Management, revenue cycle and clinical department managers to achieve maximum appropriate reimbursement. Collaborate with payer representatives to address payer denial trends/issues.
• · Develop reports and address trends as appropriate. Provide reports to clinical departments and direct corrective actions such as improved documentation, improved discharge planning etc.

· Review electronic health records for accurate and complete documentation of all relevant diagnoses and procedures.

· Communicate benefits of complete and accurate documentation to physicians relating to their daily practice of medicine.

· Work with all physician specialties in clinical documentation improvement initiatives, effectively tailoring learning and education opportunities to each physician specialty.

· Coordination of patient’s plan of care with a transdisciplinary team during the episode of illness.

· Work closely with physicians and staff to facilitate discharge within the expected length of stay.

· Coordinate and oversee utilization review of patient cases.

· Identify clinical information necessary for continued stay, using appropriate criteria measure (i.e. Interqual, Milliman).

· Chair multiple hospital meetings, including Transdisciplinary meeting, and Discharge Planning Meeting.

· Assess potential patient's condition and past medical history and obtain appropriate documentation to support long term acute care hospital eligibility.

· Monitor and support safe transition from anesthetized state to responsiveness in the postoperative patient.

· Assess patient for post-operational complications, including nausea/vomiting, pain control issues, and respiratory difficulties.

· Assess readiness and coordinate postoperative patient’s transfer out of the immediate post-anesthesia care unit.

· Preceptor for new nurses in the post-anesthesia care unit.

· Address the unique needs of the critically ill patient in the intensive care unit setting.

· Responsible for coordinating and leading the patient care team in the assessment, development, implementation, and evaluation of the critically ill patient’s care plan.

· Charge nurse for the medical intensive care unit.

· Preceptor for new nurses in the medical intensive care unit