After 35 years in nursing, Jonna Mayfield, RN, BSN, CMGT-BC, has learned that making a difference in healthcare does not always mean standing at the bedside.
Jonna began her career as a hospital nurse, spending over a decade in the emergency room before moving into nursing leadership and eventually case management. It was through case management that she discovered utilization management (UM), a field that combined her clinical experience, critical thinking, and desire to help patients in a different way.
“I think you’re an investigator,” Jonna said of utilization management. “You’re looking through the record. You’re trying to see what qualifies.”
That investigative side of the work quickly became a passion. For the past 15 years, Jonna has specialized in utilization management, including consulting with hospitals across the country on best practices, staffing challenges, and process improvement. Today, she brings that experience with her as Director of Utilization Management at Brundage Group.
Clinical Experience Meets Critical Thinking
For Jonna, her years in the emergency room continue to shape how she approaches utilization management.
The fast-paced environment taught her how to adapt quickly, while years of clinical experience strengthened the critical thinking skills she now uses to evaluate patient records and apply clinical criteria.
“You’re using your critical thinking skills as a nurse to see what qualifies in this patient’s condition.”
Jonna Mayfield, RN, BSN, CMGT-BC
That clinical perspective is what allows utilization management to go beyond checking a diagnosis against a set of criteria. It requires understanding the patient’s condition, treatment pathway, documentation, and clinical story as a whole.
It also creates opportunities for education. When documentation does not fully support a physician’s decision, Jonna’s team can engage directly with physicians to better understand the case and help strengthen the documentation.
“Over time, we’ll see an improvement just from having those brief conversations with the doctor,” Jonna said.
For her, those conversations are an important part of the work, not just correcting an individual case, but helping improve processes over time.
The Power of Education
Education is a recurring theme throughout Jonna’s approach to utilization management. She believes the strongest results come from helping healthcare teams understand the reasoning behind the work, rather than simply telling them what to do.
“I love that Brundage Group focuses on education,” she said. “We’re trying to educate as we go so that we’re actually improving processes along the way.”
That philosophy is particularly important in a field that Jonna believes is often underrepresented in traditional nursing and medical education. Understanding utilization management, documentation, and the importance of appropriate level-of-care decisions can benefit clinicians throughout their careers.
Technology as a Tool for Expertise
Jonna has watched utilization management evolve throughout her career. Early in her career, nurses relied heavily on physical books and learned many processes through trial and error. Today, technology provides faster access to information, more educational resources, and opportunities to streamline the review process.
She sees AI as another tool that can help clinicians spend less time searching through records and more time applying their expertise.
A tech-enabled review could pull together the most relevant information from a patient’s chart, potentially reducing the time a nurse spends gathering data. But Jonna is clear about where the expertise still belongs.
““It still takes that expert nurse to make sure it’s correct.”
Jonna Mayfield, RN, BSN, CMGT-BC
For Jonna, the future of utilization management isn’t replacing clinical expertise. It’s about giving experienced clinicians better tools to use that expertise more efficiently.
Making a Difference Behind the Scenes
After decades in nursing, Jonna’s motivation ultimately comes back to the same reason she entered the profession in the first place: making a difference.
And that impact doesn’t have to be visible to the patient.
“You don’t have to be at the bedside with that patient to make a difference,” she said.
A well-supported utilization management decision can help ensure a patient is placed at the appropriate level of care, while accurate documentation and review can help prevent unnecessary denials and support appropriate reimbursement for hospitals.
For Jonna, the connection between those two outcomes is what makes the work so rewarding.
“I love to see that we can decrease hospitals’ denials and we can improve their revenue,” she said. “And it’s all because of this expert team that we have that can come in and make a difference.”
After 35 years in healthcare, Jonna’s role may look very different from where she started, but her purpose hasn’t changed.
“I just have a passion for what we do and love to be able to make an impact for hospitals.” At Brundage Group, Jonna continues to bring that passion to her work every day, combining decades of clinical experience with a commitment to helping hospitals and the patients they serve.
Looking to strengthen your Utilization Management Strategy?
Strong utilization management supports both hospitals and the patients they serve. Learn how Brundage Group can help strengthen your organization’s approach.
