John Moisant

Experience

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  Savannah Regenional Youth Detention Center

  Aug 2000 - Mar 2001

  Medical Department Manager

  • Managed computer records of ordering and inventory.• Handled all aspects of policy creation and implementation.• Successfully staffed medical team including MD, PA, RNs, LPNs, Psych and Social Services.• Organized and styled care model for youth based on need and urgent care.

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  St. Joseph's/Candler

  Mar 2001 - Nov 2010

  Utilization Manager / Case Manager

  All phases of interdisciplinary practice Case Management: Assessment, DC planning, Utilization Review, outcomes management, reimbursement strategy planning within the confines of federal and state regulation.Key Achievements• Always meets or exceeds annual reviews during employment.• Successful crossover to multiple job duties to fill system needs during company transitions periods with management recognition of same.

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  Memorial University Medical Center

  Nov 2010 - Aug 2012

  Utilization Management Specialist

  Case Management with specialty skills to maximize revenue for hospital services rendered at multiple levels of care. Organized and prioritized case loads to capture time sensitive cases first. Established rapport with client physicians as well as built credibility with their staff. Optimized patient care reimbursement within guidelines and regulations. Key Achievements• Recognition for expertise in clinical evaluation , met or exceeded all employee evaluations• Obtained staff buy in to facilitate departmental goals• Reorganized job mechanics to become more efficient Show less

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  GENEX Services, Inc.

  Jan 2013 - Jul 2013

  Case Manager

  Case Management for injured workers acting as a liaison for employers, insurance companies and physicians.

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  UnitedHealth Group

  Nov 2013 - Dec 2014

  RN Utilization Review Manager

  Case Management and Utilization Review

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  CES Computer Evidence Specialists

  Dec 2014 - Aug 2015

  Lead Claims Review Analyst

  Lead claims review conducting Lead clinical claim investigations for the federal Medicare Trust Fund.

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  NaviHealth, Inc.

  Jul 2015 - Apr 2016

  Utilization Review Specialist

  Clinical review for post acute SNF/LTAC/IRF admission criteria including appeal process with issuance of approvals/NOMNC/DENC letters, partnering with physicians, hospitals and carriers.

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  IPI Travel

  Apr 2016 - Aug 2016

  RN Case Manager, Utilization Review Specialist, BSN, CCM

  All phases of acute in patient hospital case management with a team approach including physicians, therapists, social workers and administration.

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  St. Joseph's/Candler

  Aug 2016 - Nov 2017

  Clinical Care Coordinator / Utilization Review Specialist

  Clinical review of all hospitalized patients to determine correct bed status and compile a report for respective payers. Work as a liaison with physicians to obtain correct orders depending on the patient's clinical picture. Primarily utilization review and it's various facets for the whole house.

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  WellCare Health Plans

  Jan 2018 - now

  Case Manager / Utilization Review

  RN CM UM

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  Centene Corporation

  Jan 2018 - now

  Utilization Review Nurse / Case manager