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An accomplished, dynamic nursing professional who effectively combines clinical background and administrative expertise to ensure exceptional patient care. A unique background includes exposure to all types of environments, including: insurance companies, hospitals, and third-party providers. Capitalizes on 20+ years of experience to successfully manage complex and challenging cases while telecommuting. An effective communicator who easily translates medical terms/information into easy-to-understand language. A team player who readily builds relationships with clients from all socio and economic backgrounds as well as doctors, nurses, and third-party representatives.
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Case ManagerActivehealth ManagementChantilly, Va, Us
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Case ManagerActivehealth Management Aug 2013 - PresentNew York, Ny, UsProvides telecommuting case management services for moderate to catastrophic case management at all levels of care: inpatient, outpatient, skilled nursing facilities, biologic/medication review, and member and family education, etc. Services include negotiation of rates, coordination of care, discharge planning, utilization management, identification for potential quality of care and investigate cases that extend beyond outcomes or are not consistent with the standards of care. Maintained continuum of care and educated clients/subscribers as needed. -
Senior Clinical Review SpecialistHealthways Apr 2010 - Aug 2013Franklin, Tn, UsProvides senior-level review and analysis of as many as 45 cases daily, efficiently performing utilization management services of outpatient care on a high caseload. Evaluates cases using clinical criteria and applying medical necessity recommendations. Sought out by management for expertise in utilization review and case/care documentation and asked to serve on the Clinical Review as well as the Clinical Oversight Committees. Actively participates in deploying new client contracts, including identifying clinical and software/data elements. Assisted with developing and implementing new quality improvement initiatives and outcome measurement tools. Selected to manage the organization’s most complex cases. -
Team LeaderActivehealth Management 2005 - 2010New York, Ny, UsServed as a team leader to Active Health Management, a subsidiary of Aetna providing clinically focused healthcare solutions. Initially provided hands-on review of 15-20 moderate to catastrophic utilization and management cases at all levels of care: inpatient, outpatient, skilled nursing facilities, maternity, biologic/medication review, and disease management education, etc. Promoted after one year to management, ensuring consistency in interventions across membership. Focused on unit management and supervising 17 member medical services staff; 25% of time dedicated to case review. Directed daily implementation of established medical management services policies/procedures, client reporting, and development of process workflows. Held authority for meeting the financial, operational, and quality objectives of the unit while performing pre- and post-service reviews, coordination of appeals requests, and education of the providers and members regarding processes.
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Clinical Case ManagerValue Options 2000 - 2005Provided telecommuting case management services for high-risk employees and dependents for mental health, eating disorders, and substance abuse, managing up to 20 moderate/catastrophic cases simultaneously. Focused on coordination of care, benefit management, and appeal requests. Led multidisciplinary meetings to ensure quality monitoring of cases and investigate cases that extend beyond outcomes, as defined by the organization. Maintained continuum of care and educated clients/subscribers as needed.
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Nurse Case ManagerThe Mount Vernon Hospital 1993 - 2000UsAnalyzed medical records for 20+ moderate/complex cases daily for utilization management, discharge planning, and coordination of care for psychiatric, medical, and surgical clients. Focused on discharge planning, DRG (diagnosis-related group) assignment, and third-party administrators. Provided case management for work rehab clients, including report generation. Gave feedback to hospital staff and conducted in-services to train personnel in case management. Provided key information to the INOVA System Documentation Committee. -
Medical Review AnalystBlue Cross Blue Shield, Washington D.C. 1990 - 1995Performed first full time (1990-1993) then part time (1993-1995) responsibilities of case review and evaluation of 40+ cases daily. Assessed services for medical necessity, contractual limitations, patterns/trends, and quality issues. Liaised with medical advisors, nurses, service personnel/providers, and subscribers to provide a quality review for internal/external customers. Prepared and presented cases to medical advisers or peer review panel.
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Staff/Charge NurseGeorgetown University Hospital 1988 - 1990Washington, Dc, UsLed nursing function on the Orthopedic and Surgical Unit -
Staff Nurse/Clinician INational Hospital For Orthopedics & Rehabilitation 1986 - 1988Successfully functioned as a Charge Nurse and promoted to Assistant Head of Nurse. Assisted in development and implementation of patient care standards.
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Charge/Staff NurseCommunity Hospital Of Roanoke Valley | Now Jefferson 1983 - 1986Hands-on practitioner and leader on the Medical and Surgical Orthopedic units.
Claudia Porter Skills
Claudia Porter Education Details
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George Mason UniversityData Analysis And Outcomes Management In Health Care Systems -
National Louis UniversityManagement And Leadership
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Chrv School Of Nursing | Now JeffersonProfessional Nursing
Frequently Asked Questions about Claudia Porter
What company does Claudia Porter work for?
Claudia Porter works for Activehealth Management
What is Claudia Porter's role at the current company?
Claudia Porter's current role is Case Manager.
What is Claudia Porter's email address?
Claudia Porter's email address is rn****@****cox.net
What is Claudia Porter's direct phone number?
Claudia Porter's direct phone number is (212) 651*****
What schools did Claudia Porter attend?
Claudia Porter attended George Mason University, National Louis University, Chrv School Of Nursing | Now Jefferson.
What skills is Claudia Porter known for?
Claudia Porter has skills like Utilization Management, Disease Management, Nursing, Healthcare Management, Case Management, Healthcare, Utilization Review, Hospitals, Clinical Outcomes, Health Care Systems, Microsoft Office, Clinical Research.
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