Julie Dyer Pearson
Acworth
Summary
Compassionate Registered Nurse experienced in case management, utilization review, and discharge planning. Achieved improved patient satisfaction through effective patient education, health assessments, and medication administration. Focused on delivering patient-centered care and fostering strong relationships with patients and families in high-stress clinical environments.
Overview
1
1
Certification
32
32
years of professional experience
Work History
Target Review Nurse
Kaiser Permanente
02.2022 - 04.2026
- Approved or denied services based on medical necessity; escalated complex cases to MD for further evaluation.
- Review outpatient/inpatient requests using MCG, CMS, and Kaiser criteria.
- Managed quality resource reviews, ensuring adherence to healthcare standards and enhancing service delivery.
- Collaborate with interdisciplinary teams to support patient care goals.
- Conducted clinical research to ensure comprehensive documentation for patient care decisions.
Utilization Review Nurse
Aerotek Staffing
07.2021 - 02.2022
- Conducted utilization review and medical necessity determinations to ensure compliance with clinical guidelines.
- Kaiser Permanente (QRM/TR)
- Analyzed patient data to determine medical necessity for treatments.
- Reviewed medical records for appropriateness of care and services.
- Collaborated with healthcare providers to ensure compliance with guidelines.
- Coordinated approval processes for various treatment plans and procedures.
- Documented findings and decisions in electronic health record systems.
- Educated patients on insurance coverage and benefits related to care.
- Served as a resource for staff members seeking guidance on utilization review matters.
Discharge Planning, Denials & Appeals
Wellstar Health System
01.2019 - 07.2021
- Coordinated discharge planning for complex inpatient cases, improving patient transition to post-acute care.
- Managed appeals and denials, ensuring compliance with regulatory standards and reducing potential financial liabilities.
- Supervised neurology back-office clinical operations, enhancing workflow efficiency and supporting patient care delivery.
Utilization Review Nurse
Kaiser Permanente
12.2006 - 12.2018
- Conducted concurrent inpatient reviews for non-core facilities.
- Reviewed medical records for appropriateness of care and services.
- Coordinated SAR, LTAC, and rehab placements, ensuring timely and appropriate patient transitions.
- Assessed admissions, continued stays, and discharge needs.
- Worked as QRM and concurrent review nurse, evaluating patient care processes.
- Reviewed medical records to assess appropriateness of care and services, contributing to quality assurance.
- Collaborated with healthcare providers to ensure adherence to guidelines, enhancing care delivery.
- Trained new staff on case management protocols and procedures.
- Worked remotely since 2008, maintaining high productivity levels.
Staff Nurse
Wellstar Health System
02.2002 - 10.2007
- Delivered comprehensive direct patient care on med-surg and specialty units, ensuring adherence to treatment plans and enhancing patient comfort.
- Administered medications and monitored patient reactions effectively.
- Collaborated with interdisciplinary teams to develop care plans.
- Provided compassionate patient care in diverse medical settings.
ICU & Med/Surg Nurse
Cartersville Medical Center
06.2000 - 08.2002
Additional RN Roles (19942000)
01.1994 - 01.2000
- Supported patient care as back office RN, coordinated utilization review as UR nurse, and supervised staff in neurology, ENT, pulmonary, and family practice settings.
- Administered medications and treatments according to established protocols.
- Monitored patient vital signs and reported changes to healthcare team.
- Educated patients and families on disease management and discharge instructions.
Education
BSN -
Skills
- Patient assessment & care planning
- Full episode case management
- Medical necessity determinations
- Utilization review guidelines
- Discharge planning
- Regulatory compliance
- Patient and caregiver education
- Interdisciplinary collaboration
- Interdisciplinary communication
- EMR documentation & Windows-based systems
- Patient and caregiver education
- Claims resolution
Certification
- RN, BSN
- BLS Certified
- Georgia RN License/COMPACT License
- Valid Driver's License & Vehicle Insurance
Timeline
Target Review Nurse
Kaiser Permanente
02.2022 - 04.2026
Utilization Review Nurse
Aerotek Staffing
07.2021 - 02.2022
Discharge Planning, Denials & Appeals
Wellstar Health System
01.2019 - 07.2021
Utilization Review Nurse
Kaiser Permanente
12.2006 - 12.2018
Staff Nurse
Wellstar Health System
02.2002 - 10.2007
ICU & Med/Surg Nurse
Cartersville Medical Center
06.2000 - 08.2002
Additional RN Roles (19942000)
01.1994 - 01.2000