Althea N. Johnson

Dedicated and knowledgeable Healthcare Professional with twenty years of Managed Care/Health Plan experience and eight years of staff Nursing experience. Experienced in Disease Management, Device Management, Maternity Care Management, Perinatal Mood Disorder and Anxiety Disorder Case Management, Transitional Care, Discharge Planning, Utilization Management, HEDIS Measures, and Population Health. I take pride in the ability to work independently or within a team environment.

I am a Proactive team player, frequently assisting in completing special projects and challenging assignments.

Senior Case Manager - Centene

(2020-01)

Centene is a Managed Care Organization that specializes in managing the health of government-sponsored programs such as Medicaid, Medicare, Affordable Care, and Foster Care.

• Care Management for High-Risk Pregnant Women diagnosed with Perinatal Mood Disorders and Anxiety during the prenatal and Post-Partum Phase
• Conduct Comprehensive Need Assessments
• Conduct Trimester-Based Assessments
• Anxiety and Depression Assessments
• Provide Education on High-Risk Pregnancy Disorders, namely: Preeclampsia, Gestational Diabetes, Hyperemesis Gravidarum & Preterm Labor
• Care Coordination for services for Pregnant women with Social Determinants of Health Needs
• Facilitate referral to Community Programs such as County Healthy Start and Doula Services
• Medication Management & Care Planning
• Interdisciplinary Team Rounds

Transitional Care Case Manager for Medicaid and The Affordable Care Act Patients - Centene

(2016-01 - 2020-08)

Centene is a Managed Care Organization that specializes in managing the health of government-sponsored programs such as Medicaid, Medicare, Affordable Care, and Foster Care.

• Initiate Transitional of Care Assessment on Members, Caregivers, and Providers in accordance with the Agency of Health Care Administration Guidelines
• Collaborate with Utilization Management staff regarding members' discharge needs and facilitate the transfer and/or discharge from the hospital, skilled nursing facilities, Home Health Care Agency, Shelters, and Home
• Collaborate with The Prior Authorization Staff to ensure Patients receive Durable Medical devices promptly
• Assist in the initiation of Single Case Agreements
• Participate in Hospital Interdisciplinary Rounds to identify resources to improve quality of Care, reduce Length of inpatient Stay, and eliminate barriers to discharge
• Assist with scheduling post-discharge follow-up appointments with Physicians
• Participate in the High Utilization Rounds to reduce the readmission rate for Medicaid and the Affordable Health Care Act Patients
• Response to Agency for Health Care Administration complaints
• Maintain the accuracy of the medical Record utilizing HIPAA standards
• HEDIS Data collection
• Initiate Care Plans

Disease Manager/Personal Health Consultant/Care Manager/Population Health Manager - UnitedHealthcare/Alere Health Inc./Matria Health Care

(2006-05 - 2016-01)

Alere is a Global manufacturer of rapid point-of-care diagnostic tests. Matria is an Innovative company specializing in diagnostic products and managed care programs. United Health is a Commercial Insurance/Managed Care Organization.

• Telephonic use of Motivational Interviewing Skills to educate and support individuals in self-managing chronic conditions: Diabetes, Coronary Heart Disease, Congestive Heart Failure, Chronic Obstructive Pulmonary Disease, and Asthma
• This was achieved through goal-oriented programs and the use of disease management guidelines
• Initiated patient activation in the appropriate disease management program
• Defined and determined realistic goals with program participants
• Promoted wellness and provided education regarding preventative care measures
• Promote treatment compliance to reduce utilization

Nursing Supervisor - Ft Lauderdale Health and Rehabilitation Center

(2007-07 - 2008-03)

Supervision of care at a 183 bed-Skill Nursing Facility

Staff Nurse - Various Settings

(1998-04 - 2006-11)

Specialized in Medical Surgical Nursing (Cardiology) in various settings: Hospitals, Outpatient Pediatrics, Long-term Care, Home Health, and the Travelling Nurse Industry.

Bachelor of Science - Nursing - University of Phoenix (2012)

Associate of Science - Nursing - Oakwood University (1997)

Business Administration - College of Arts, Science and Technology (1992)