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John Moisant

John Moisant has over 25 years of experience in case management and utilization review. He has held various roles as a case manager, utilization review coordinator, and fraud investigation analyst. Most recently, he worked as a utilization review coordinator at St. Joseph's Candler Hospital in Savannah, GA, independently handling all phases of utilization review for the entire hospital. He holds certifications in case management and as a registered nurse.

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John Moisant RN, BSN, CCM Savannah, GA Mojolattes@gmail.com - 9125478205 Extensive Case Management and Utilization Review experience Authorized to work in the US for any employer WORK EXPERIENCE Utilization Review Coordinator St. Joseph's Candler Hospital - Savannah, GA All phases of utilization review for entire hospital working independently. Case Manager IPI - Noblesville, IN - April 2016 to August 2016 All phases of acute "in patient" hospital Case management with team approach including care track with physicians, nursing and therapies. Utilization Review Specialist NaviHealth - Nashville, TN - August 2015 to April 2016 Responsibilities Clinical review for the most appropriate discharge disposition from various levels of care. Determination for authorization of services based on Interqual criteria. Accomplishments Facilitated quality customer service while maintaining accurate clinical decision making and assisting other employees with instruction on procedure or technical help as needed. Skills Used Analytical application of Interqual and Medicare rules to correctly determine the most appropriate level of care for the patient based on applied criteria and clinical judgement. Fraud Investigation Analyst Computer Evidence Specialists - Saint Augustine Beach, FL - December 2014 to August 2015 Responsibilities Working with the investigation team and reviewing clinical to ascertain fraudulent activity by healthcare providers. Contract by CMS with use of it's national data base MCS Medicare portal including associated security clearance. Accomplishments Facilitated team goals to achieve an accurate objective finding on each case and report. Skills Used Analytic competence with deciphering Medicare and federal rules/regulations that impact provider services. RN Case Manager
United Healthcare - Savannah, GA - November 2013 to November 2014 Responsibilities Case management and utilization review onsite for St. Joseph's, Candler and Memorial University Medical Center including clinical assessment as well as case management continuum of care coordination. Accomplishments Achieved 92 and 95% on recent quality performance audits. Skills Used Clinical evaluation and coordination of resources with hospital staff. Case Manager / Utilization Review GENEX - Savannah, GA - January 2013 to July 2013 Responsibilities This position entailed workmans compensation case management acting as a liaison for patients, physicians, insurance companies and employers. Accomplishments Case Management and Rehab license Certified. Skills Used Established rapport with physicians and Insurance companies as well as patients, facilitating expedient recovery and goal attainment for all interested parties. Case Manager / Utilization Review Memorial University Medical Center - Savannah, GA - November 2010 to January 2013 Responsibilities Utilization Review Management Specialist This role involved Case Management and Utilization review with high level critical thinking skills working closely with the RNs and physicians to evaluate clinical information and determine optimal billing status. Accomplishments Seasoned understanding of clinical and billing implications essential for expedient success. Skills Used Critical thinking with team approach to achieve authorization for " IN Patient Vs. Out Patient" designation as appropriate on my clinical assessment. Case Manager / Utilization Review St. Joseph's Hospital - Savannah, GA - March 2001 to November 2010 Responsibilities - Extensive Utilization review and Case management experience covering the entire hospital including neuro, cardiac, med/surg, ortho, GI, and ED. Held both case management and utilization management roles during this 9 year period. Accomplishments Held certification in UM and CM via the American Nurse Credentialing Center. Skills Used
Performed detailed decision making on OBS vs in patient bed status converting the patient to the most appropriate level of care and obtaining MD order for same. EDUCATION Bachelors of Science in Nursing Olivet Nazarene University - Bourbonnais, IL 1990 to 1993 SKILLS Case Management (10+ years), Utilization Review (10+ years) MILITARY SERVICE Service Country: United States Branch: Navy Rank: E-3 CERTIFICATIONS CCM May 2018 Registered Nurse September 2017 ADDITIONAL INFORMATION Active Registered nurse licensing without restriction in all compact states as well as Illinois, Georgia and California.

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  • 1. John Moisant RN, BSN, CCM Savannah, GA Mojolattes@gmail.com - 9125478205 Extensive Case Management and Utilization Review experience Authorized to work in the US for any employer WORK EXPERIENCE Utilization Review Coordinator St. Joseph's Candler Hospital - Savannah, GA All phases of utilization review for entire hospital working independently. Case Manager IPI - Noblesville, IN - April 2016 to August 2016 All phases of acute "in patient" hospital Case management with team approach including care track with physicians, nursing and therapies. Utilization Review Specialist NaviHealth - Nashville, TN - August 2015 to April 2016 Responsibilities Clinical review for the most appropriate discharge disposition from various levels of care. Determination for authorization of services based on Interqual criteria. Accomplishments Facilitated quality customer service while maintaining accurate clinical decision making and assisting other employees with instruction on procedure or technical help as needed. Skills Used Analytical application of Interqual and Medicare rules to correctly determine the most appropriate level of care for the patient based on applied criteria and clinical judgement. Fraud Investigation Analyst Computer Evidence Specialists - Saint Augustine Beach, FL - December 2014 to August 2015 Responsibilities Working with the investigation team and reviewing clinical to ascertain fraudulent activity by healthcare providers. Contract by CMS with use of it's national data base MCS Medicare portal including associated security clearance. Accomplishments Facilitated team goals to achieve an accurate objective finding on each case and report. Skills Used Analytic competence with deciphering Medicare and federal rules/regulations that impact provider services. RN Case Manager
  • 2. United Healthcare - Savannah, GA - November 2013 to November 2014 Responsibilities Case management and utilization review onsite for St. Joseph's, Candler and Memorial University Medical Center including clinical assessment as well as case management continuum of care coordination. Accomplishments Achieved 92 and 95% on recent quality performance audits. Skills Used Clinical evaluation and coordination of resources with hospital staff. Case Manager / Utilization Review GENEX - Savannah, GA - January 2013 to July 2013 Responsibilities This position entailed workmans compensation case management acting as a liaison for patients, physicians, insurance companies and employers. Accomplishments Case Management and Rehab license Certified. Skills Used Established rapport with physicians and Insurance companies as well as patients, facilitating expedient recovery and goal attainment for all interested parties. Case Manager / Utilization Review Memorial University Medical Center - Savannah, GA - November 2010 to January 2013 Responsibilities Utilization Review Management Specialist This role involved Case Management and Utilization review with high level critical thinking skills working closely with the RNs and physicians to evaluate clinical information and determine optimal billing status. Accomplishments Seasoned understanding of clinical and billing implications essential for expedient success. Skills Used Critical thinking with team approach to achieve authorization for " IN Patient Vs. Out Patient" designation as appropriate on my clinical assessment. Case Manager / Utilization Review St. Joseph's Hospital - Savannah, GA - March 2001 to November 2010 Responsibilities - Extensive Utilization review and Case management experience covering the entire hospital including neuro, cardiac, med/surg, ortho, GI, and ED. Held both case management and utilization management roles during this 9 year period. Accomplishments Held certification in UM and CM via the American Nurse Credentialing Center. Skills Used
  • 3. Performed detailed decision making on OBS vs in patient bed status converting the patient to the most appropriate level of care and obtaining MD order for same. EDUCATION Bachelors of Science in Nursing Olivet Nazarene University - Bourbonnais, IL 1990 to 1993 SKILLS Case Management (10+ years), Utilization Review (10+ years) MILITARY SERVICE Service Country: United States Branch: Navy Rank: E-3 CERTIFICATIONS CCM May 2018 Registered Nurse September 2017 ADDITIONAL INFORMATION Active Registered nurse licensing without restriction in all compact states as well as Illinois, Georgia and California.